Survival differences between HER2-0 and HER2-low-expressing breast cancer - A meta-analysis of early breast cancer patients

Ciqiu Yang; Xiaoqi Zhang; Yitian Chen; Peiyong Li; Junsheng Zhang; Aiqi Xu; Na Huang; Minting Liang; Yilin Chen; Kun Wang

doi:10.1016/j.critrevonc.2023.103962

Survival differences between HER2-0 and HER2-low-expressing breast cancer - A meta-analysis of early breast cancer patients

Crit Rev Oncol Hematol. 2023 May:185:103962. doi: 10.1016/j.critrevonc.2023.103962. Epub 2023 Mar 14.

Authors

Ciqiu Yang¹, Xiaoqi Zhang², Yitian Chen¹, Peiyong Li³, Junsheng Zhang¹, Aiqi Xu⁴, Na Huang⁵, Minting Liang⁶, Yilin Chen⁴, Kun Wang⁷

Affiliations

¹ Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China.
² Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China; The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
³ Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China; Guangdong Medical University, Zhanjiang 524000, China.
⁴ School of Medicine, South China University of Technology, Guangzhou University Town, Guangzhou 510006, China.
⁵ The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
⁶ Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China; Shantou University Medical College, Guangdong, China.
⁷ Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China. Electronic address: gzwangkun@126.com.

PMID: 36921780
DOI: 10.1016/j.critrevonc.2023.103962

Abstract

Background: HER2-low (human epidermal growth factor receptor 2) breast cancer takes up 40-50% in all breast cancer subtypes. The survival difference between HER2-low and HER2-zero breast cancers remain uncertain. Therefore, the aim of this study was to compare survival outcome of the two subtypes and to explore the impact of hormone receptor status.

Methods: A comprehensive medical literature search was performed by searching PubMed, EMBASE, and the Cochrane Libraries up to August 2022. We included observational studies reporting hazard ratios (HRs) with corresponding 95% confidence intervals (CIs). The results of individual studies were pooled by random-effects models using Stata 16.0. Seventeen articles with a total of 78984 breast cancer patients were included in the meta-analysis.

Results: We observed a statistically significant association between low HER2 expression and better breast cancer survival outcomes (OS: HR: 0.83; 95% confidence interval: 0.75, 0.90; DFS/RFS: HR: 0.83; 95% confidence interval: 0.75, 0.91). In a subgroup analysis, we found that HER2-low patients had better survival outcomes relative to hormone receptor-positive breast cancer patients (OS: HR: 0.87; 95% confidence interval: 0.81, 0.93; DFS/RFS: HR: 0.91; 95% confidence interval: 0.85, 0.96). Similarly, in triple-negative breast cancer patients, we also observed a positive association between HER2 low expression and better survival (OS: HR: 0.85; 95% confidence interval: 0.71, 0.98; DFS/RFS: HR: 0.85; 95% confidence interval: 0.74, 0.95).

Conclusions: Our study showed that HER2-low breast cancer had better survival outcomes compared to HER2 negative breast cancer in patients with early stage breast cancer, regardless of hormone receptor status.

Registration: This meta-analysis was registered with PROSPERO (CRD42022335704) on June 10, 2022.

Availability of data and materials: All data generated or analysed during this study are included in this published article [and its supplementary information files].

Keywords: HER2-low-expressing breast cancer; HER2-zero breast cancer; Survival.

Publication types

Meta-Analysis
Review

MeSH terms

Breast Neoplasms* / metabolism
Breast Neoplasms* / mortality
Female
Humans
Prognosis
Proportional Hazards Models
Receptor, ErbB-2* / genetics
Receptor, ErbB-2* / metabolism
Triple Negative Breast Neoplasms* / metabolism
Triple Negative Breast Neoplasms* / mortality

Substances

Receptor, ErbB-2