Clinical characteristics and predictive models of HER2-low breast cancer patients who only received adjuvant chemotherapy: a real-world retrospective multicenter study

Abstract HER2-low positivity is reported to play substantial role in neoadjuvant chemotherapy for breast cancer, but its role in adjuvant chemotherapy remains unclear. We aim to explore the role of HER2-low positivity in the breast cancer patients who only received adjuvant chemotherapy. We evaluate...

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Main Authors: Qinchuan Wang, Yuying Wang, Zikang Chen, Yuqing Chao, Lin Chen, Wenjing Li, Xia Yang, Zhinong Jiang, Xiaoyan Li, Bo Gao, Wenxian Hu, Jichun Zhou, Linbo Wang, Haitao Li, Jun Zhang, Qiong Ding, Xudong Lv, Hao Zhang, Heming Zheng
Format: Article
Language:English
Published: Nature Portfolio 2025-07-01
Series:npj Precision Oncology
Online Access:https://doi.org/10.1038/s41698-025-00998-3
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author Qinchuan Wang
Yuying Wang
Zikang Chen
Yuqing Chao
Lin Chen
Wenjing Li
Xia Yang
Zhinong Jiang
Xiaoyan Li
Bo Gao
Wenxian Hu
Jichun Zhou
Linbo Wang
Haitao Li
Jun Zhang
Qiong Ding
Xudong Lv
Hao Zhang
Heming Zheng
author_facet Qinchuan Wang
Yuying Wang
Zikang Chen
Yuqing Chao
Lin Chen
Wenjing Li
Xia Yang
Zhinong Jiang
Xiaoyan Li
Bo Gao
Wenxian Hu
Jichun Zhou
Linbo Wang
Haitao Li
Jun Zhang
Qiong Ding
Xudong Lv
Hao Zhang
Heming Zheng
author_sort Qinchuan Wang
collection DOAJ
description Abstract HER2-low positivity is reported to play substantial role in neoadjuvant chemotherapy for breast cancer, but its role in adjuvant chemotherapy remains unclear. We aim to explore the role of HER2-low positivity in the breast cancer patients who only received adjuvant chemotherapy. We evaluated 3214 patients from SRRSH Hospital and 16,273 patients from CHLP Hospital. All the patients were diagnosed as primary breast cancer who only received adjuvant chemotherapy. HER2-status was defined according to ASCO/CAP guidelines. Multivariable Cox models and machine learning models were applied in the analysis of overall survival. A total of 1009 HER2-zero, 1399 HER2-low and 806 HER2-positive patients were included in SRRSH cohort, while there were 5662 HER2-zero, 6471 HER2-low and 4140 HER2-positive patients in CHLP cohort. HER2-low patients showed significant better OS and reduced death risk compare to HER2-zero patients in both SRRSH (log-rank p = 0.033, HR = 0.62, 95% CI 0.39–0.97, p = 0.037) and CHLP cohort (log-rank p < 0.001, HR = 0.63, 95% CI 0.55–0.73, p < 0.001). In subgroup analysis, HER2-low patients had significantly reduced risk of death compare to HER2-zero patients in hormonal receptor-positive subset in both cohorts, but not in hormonal receptor-negative subset. MLP model demonstrated the best performance among all the predictive models in both cohorts. Our study indicated that HER2-low patients had better survival compare to HER2-zero patients in adjuvant chemotherapy only setting. We emphasized the significance of HER2 status in adjuvant setting in BC, implying more precise diagnostic and therapeutic strategies in future.
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spelling doaj-art-fe5ff02265ee4100889f8d1ecb9b1d772025-08-20T03:45:18ZengNature Portfolionpj Precision Oncology2397-768X2025-07-019111110.1038/s41698-025-00998-3Clinical characteristics and predictive models of HER2-low breast cancer patients who only received adjuvant chemotherapy: a real-world retrospective multicenter studyQinchuan Wang0Yuying Wang1Zikang Chen2Yuqing Chao3Lin Chen4Wenjing Li5Xia Yang6Zhinong Jiang7Xiaoyan Li8Bo Gao9Wenxian Hu10Jichun Zhou11Linbo Wang12Haitao Li13Jun Zhang14Qiong Ding15Xudong Lv16Hao Zhang17Heming Zheng18Department of Surgical Oncology, Affiliated Sir Run Run Shaw Hospital, Zhejiang University School of MedicineDepartment of Breast Surgery, Cancer Hospital of China Medical University, Cancer Hospital of Dalian University of Technology, Liaoning Cancer Hospital & InstituteCollege of Biomedical Engineering and Instrument Science, Zhejiang UniversitySchool of Public Health, Zhejiang University School of MedicineSchool of Public Health, Zhejiang University School of MedicineSchool of Public Health, Zhejiang University School of MedicineDepartment of Pathology, Affiliated Sir Run Run Shaw Hospital, Zhejiang University School of MedicineDepartment of Pathology, Affiliated Sir Run Run Shaw Hospital, Zhejiang University School of MedicineDepartment of Pathology, Cancer Hospital of China Medical University, Cancer Hospital of Dalian University of Technology, Liaoning Cancer Hospital & InstituteDepartment of Pathology, Cancer Hospital of China Medical University, Cancer Hospital of Dalian University of Technology, Liaoning Cancer Hospital & InstituteDepartment of Surgical Oncology, Affiliated Sir Run Run Shaw Hospital, Zhejiang University School of MedicineDepartment of Surgical Oncology, Affiliated Sir Run Run Shaw Hospital, Zhejiang University School of MedicineDepartment of Surgical Oncology, Affiliated Sir Run Run Shaw Hospital, Zhejiang University School of MedicineDepartment of Pathology, Cancer Hospital of China Medical University, Cancer Hospital of Dalian University of Technology, Liaoning Cancer Hospital & InstituteDepartment of Clinical Laboratory, Affiliated Sir Run Run Shaw Hospital, Zhejiang University School of MedicineDepartment of General Surgery, People’s Hospital of Putuo DistrictCollege of Biomedical Engineering and Instrument Science, Zhejiang UniversityDepartment of Breast Surgery, Cancer Hospital of China Medical University, Cancer Hospital of Dalian University of Technology, Liaoning Cancer Hospital & InstituteDepartment of Surgical Oncology, Affiliated Sir Run Run Shaw Hospital, Zhejiang University School of MedicineAbstract HER2-low positivity is reported to play substantial role in neoadjuvant chemotherapy for breast cancer, but its role in adjuvant chemotherapy remains unclear. We aim to explore the role of HER2-low positivity in the breast cancer patients who only received adjuvant chemotherapy. We evaluated 3214 patients from SRRSH Hospital and 16,273 patients from CHLP Hospital. All the patients were diagnosed as primary breast cancer who only received adjuvant chemotherapy. HER2-status was defined according to ASCO/CAP guidelines. Multivariable Cox models and machine learning models were applied in the analysis of overall survival. A total of 1009 HER2-zero, 1399 HER2-low and 806 HER2-positive patients were included in SRRSH cohort, while there were 5662 HER2-zero, 6471 HER2-low and 4140 HER2-positive patients in CHLP cohort. HER2-low patients showed significant better OS and reduced death risk compare to HER2-zero patients in both SRRSH (log-rank p = 0.033, HR = 0.62, 95% CI 0.39–0.97, p = 0.037) and CHLP cohort (log-rank p < 0.001, HR = 0.63, 95% CI 0.55–0.73, p < 0.001). In subgroup analysis, HER2-low patients had significantly reduced risk of death compare to HER2-zero patients in hormonal receptor-positive subset in both cohorts, but not in hormonal receptor-negative subset. MLP model demonstrated the best performance among all the predictive models in both cohorts. Our study indicated that HER2-low patients had better survival compare to HER2-zero patients in adjuvant chemotherapy only setting. We emphasized the significance of HER2 status in adjuvant setting in BC, implying more precise diagnostic and therapeutic strategies in future.https://doi.org/10.1038/s41698-025-00998-3
spellingShingle Qinchuan Wang
Yuying Wang
Zikang Chen
Yuqing Chao
Lin Chen
Wenjing Li
Xia Yang
Zhinong Jiang
Xiaoyan Li
Bo Gao
Wenxian Hu
Jichun Zhou
Linbo Wang
Haitao Li
Jun Zhang
Qiong Ding
Xudong Lv
Hao Zhang
Heming Zheng
Clinical characteristics and predictive models of HER2-low breast cancer patients who only received adjuvant chemotherapy: a real-world retrospective multicenter study
npj Precision Oncology
title Clinical characteristics and predictive models of HER2-low breast cancer patients who only received adjuvant chemotherapy: a real-world retrospective multicenter study
title_full Clinical characteristics and predictive models of HER2-low breast cancer patients who only received adjuvant chemotherapy: a real-world retrospective multicenter study
title_fullStr Clinical characteristics and predictive models of HER2-low breast cancer patients who only received adjuvant chemotherapy: a real-world retrospective multicenter study
title_full_unstemmed Clinical characteristics and predictive models of HER2-low breast cancer patients who only received adjuvant chemotherapy: a real-world retrospective multicenter study
title_short Clinical characteristics and predictive models of HER2-low breast cancer patients who only received adjuvant chemotherapy: a real-world retrospective multicenter study
title_sort clinical characteristics and predictive models of her2 low breast cancer patients who only received adjuvant chemotherapy a real world retrospective multicenter study
url https://doi.org/10.1038/s41698-025-00998-3
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