Effect of HER2 expression status on the prognosis of patients with HR(+)/HER2(‑) advanced breast cancer undergoing advanced first‑line endocrine therapy

The present study aimed to retrospectively assess the effects of human epidermal growth factor receptor 2 (HER2) expression on the diagnosis of patients with hormone receptor (HR)(+)/HER2(−) late-stage breast cancer undergoing advanced first-line endocrine-based treatment. A total of 72 late-stage breast tumor cases from June 2017 to June 2019 were selected from the Department of Surgical Oncology, Shaanxi Provincial People's Hospital (Xi'an, China) and included in the present study. The expression of estrogen receptor, progesterone receptor and HER2 was detected by immunohistochemistry. The subjects were divided into two groups: the HER2-negative (0) cohort (n=31) and the HER2 low expression cohort (n=41). The age, BMI, Karnofsky Performance Status (KPS) score, tumor size, lymph node metastasis, pathological type, Ki-67 expression and menopausal status of the patients were obtained through the electronic medical record system of Shaanxi Provincial People's Hospital. Progression-free survival (PFS) and overall survival (OS) were evaluated for all patients. The median PFS and OS of the HER2(0) cohort were longer than those of the HER2 low expression cohort (all P<0.05). It was shown that age (hazard ratio, 6.000 and 5.465), KPS score (hazard ratio, 4.000 and 3.865), lymph node metastasis (hazard ratio, 3.143; 2.983) and HER2 status (hazard ratio, 3.167 and 2.996) were independent influencing factors of the prognosis of patients with HR(+)/HER2(−) advanced breast cancer (ABC) (all P<0.05). Three models (model 1, no parameters adjusted; model 2, BMI, tumor size, pathological type, Ki-67 and menopausal status adjusted; and model 3, age, KPS functional status score and lymph node metastasis adjusted based on model 2) were established within the HER2(0) cohort as the reference for statistical analysis using the multivariate Cox's regression test. In models 2 and 3, the risk of poor prognosis of ABC within the HER2 low expression cohort was significantly higher compared with that in the HER2(0) cohort (hazard ratio, 3.558 and 4.477; 95% CI, 1.349-9.996 and 1.933-11.586; P=0.003 and P<0.001). The HER2 expression status of patients with HR(+)/HER2(−) ABC receiving advanced first-line endocrine therapy may affect PFS and OS.