Top

Breast Cancer Research and Treatment

Published in:

01-04-2020 | Breast Cancer | Epidemiology

The prognostic value of HER2 status and efficacy of anti-HER2 therapy in patients with HR-positive mucinous breast cancer: a nationwide study from the Korean Breast Cancer Society

Authors: Hyung Suk Kim, Tae Kyung Yoo, Woo Chan Park, Byung Joo Chae

Published in: Breast Cancer Research and Treatment | Issue 2/2020

Abstract

Purpose

The effect of human epidermal growth factor receptor 2 (HER2) status on mucinous carcinoma (MC) of the breast is unknown due to the rarity of HER2-positive cases. We evaluated the prognostic value of HER2 status and the efficacy of anti-HER2 therapy in patients with hormone receptor (HR)-positive MC.

Methods

From the data of 154,661 patients recorded in the Korean Breast Cancer Registry between January 1990 and August 2016, 3076 (2.0%) were diagnosed with MC. Overall survival (OS) according to HER2 status and anti-HER2 therapy was analyzed using Kaplan–Meier estimates. Multivariate analysis was performed using the Cox proportional hazards model to estimate the adjusted hazards ratio (HR) for clinicopathologic factors.

Results

A total of 2716 HR-positive MC patients were enrolled and followed up for a median 100.1 months. Of these, 2094 (77.1%) were HER2-negative and 228 (8.4%) were HER2-positive. HR-positive, HER2-positive MC patients had more advanced pathologic tumor stages (T3 or T4) (p = 0.001), more axillary lymph node involvement (p < 0.001), higher nuclear grade (p < 0.001), and more lymphovascular invasion (p = 0.012) than HER2-negative patients. Subgroup analysis of HR-positive, node-positive MC showed that HER2-positive MC was an independent prognostic factor for OS (HR = 2.657; 95% CI, 1.665–4.241; p < 0.001). HR-positive, node-positive, and HER2-negative MC had significantly longer OS than HER2-positive MBC (p = 0.017). The node-positive subgroup that received anti-HER2 therapy had increased OS, although not significantly (p = 0.224).

Conclusion

Our nationwide database study revealed that HER2-positive status was associated with worse prognosis in HR-positive and node-positive MC. Anti-HER2 therapy might be beneficial in HR-positive, node-positive, and HER2-positive MC.

Available only for authorised users

Azzopardi JG, Ahmed A, Millis RR (1979) Problems in breast pathology. Major Probl Pathol 11(i-xvi):1–466

Fentiman IS, Millis RR, Smith P, Ellul JP, Lampejo O (1997) Mucoid breast carcinomas: histology and prognosis. Br J Cancer 75(7):1061–1065CrossRefPubMedPubMedCentral

Komaki K, Sakamoto G, Sugano H, Morimoto T, Monden Y (1988) Mucinous carcinoma of the breast in Japan: a prognostic analysis based on morphologic features. Cancer 61(5):989–996CrossRefPubMed

Gallager HS (1984) Pathologic types of breast-cancer—their prognoses. Cancer 53(3):623–629. https://doi.org/10.1002/1097-0142(19840201)53:3+%3c623:Aid-Cncr2820531307%3e3.0.Co;2-Z CrossRefPubMed

Lacroix-Triki M, Suarez PH, MacKay A, Lambros MB, Natrajan R, Savage K, Geyer FC, Weigelt B, Ashworth A, Reis-Filho JS (2010) Mucinous carcinoma of the breast is genomically distinct from invasive ductal carcinomas of no special type. J Pathol 222(3):282–298. https://doi.org/10.1002/path.2763 CrossRefPubMed

Bae SY, Choi MY, Cho DH, Lee JE, Nam SJ, Yang JH (2011) Mucinous carcinoma of the breast in comparison with invasive ductal carcinoma: clinicopathologic characteristics and prognosis. J Breast Cancer 14(4):308–313. https://doi.org/10.4048/jbc.2011.14.4.308 CrossRefPubMedPubMedCentral

Rasmussen BB, Rose C, Christensen IB (1987) Prognostic factors in primary mucinous breast carcinoma. Am J Clin Pathol 87(2):155–160CrossRefPubMed

Avisar E, Khan MA, Axelrod D, Oza K (1998) Pure mucinous carcinoma of the breast: a clinicopathologic correlation study. Ann Surg Oncol 5(5):447–451CrossRefPubMed

Ranade A, Batra R, Sandhu G, Chitale RA, Balderacchi J (2010) Clinicopathological evaluation of 100 cases of mucinous carcinoma of breast with emphasis on axillary staging and special reference to a micropapillary pattern. J Clin Pathol 63(12):1043–1047. https://doi.org/10.1136/jcp.2010.082495 CrossRefPubMed

10.

Cao AY, He M, Liu ZB, Di GH, Wu J, Lu JS, Liu GY, Shen ZZ, Shao ZM (2012) Outcome of pure mucinous breast carcinoma compared to infiltrating ductal carcinoma: a population-based study from China. Ann Surg Oncol 19(9):3019–3027. https://doi.org/10.1245/s10434-012-2322-6 CrossRefPubMed

11.

Di Saverio S, Gutierrez J, Avisar E (2008) A retrospective review with long term follow up of 11,400 cases of pure mucinous breast carcinoma. Breast Cancer Res Treat 111(3):541–547. https://doi.org/10.1007/s10549-007-9809-z CrossRefPubMed

12.

Goetz MP, Gradishar WJ, Anderson BO, Abraham J, Aft R, Allison KH, Blair SL, Burstein HJ, Dang C, Elias AD, Farrar WB, Giordano SH, Goldstein LJ, Isakoff SJ, Lyons J, Marcom PK, Mayer IA, Moran MS, Mortimer J, O'Regan RM, Patel SA, Pierce LJ, Reed EC, Rugo HS, Sitapati A, Smith KL, Smith ML, Soliman H, Telli ML, Ward JH, Young JS, Shead DA, Kumar R (2019) NCCN guidelines insights: breast cancer, version 3.2018. J Natl Compr Canc Netw 17(2):118–126. https://doi.org/10.6004/jnccn.2019.0009 CrossRefPubMed

13.

Fu J, Wu L, Jiang M, Li D, Jiang T, Hong Z, Wang F, Li S (2016) Clinical nomogram for predicting survival outcomes in early mucinous breast cancer. PLoS ONE 11(10):e016492. https://doi.org/10.1371/journal.pone.0164921 CrossRefPubMedPubMedCentral

14.

Slamon DJ, Clark GM, Wong SG, Levin WJ, Ullrich A, Mcguire WL (1987) Human-breast cancer—correlation of relapse and survival with amplification of the Her-2 neu oncogene. Science 235(4785):177–182. https://doi.org/10.1126/science.3798106 CrossRefPubMed

15.

Gonzalez-Angulo AM, Litton JK, Broglio KR, Meric-Bernstam F, Rakkhit R, Cardoso F, Peintinger F, Hanrahan EO, Sahin A, Guray M, Larsimont D, Feoli F, Stranzl H, Buchholz TA, Valero V, Theriault R, Piccart-Gebhart M, Ravdin PM, Berry DA, Hortobagyi GN (2009) High risk of recurrence for patients with breast cancer who have human epidermal growth factor receptor 2-positive, node-negative tumors 1 cm or smaller. J Clin Oncol 27(34):5700–5706. https://doi.org/10.1200/Jco.2009.23.2025 CrossRefPubMedPubMedCentral

16.

Elston CW, Ellis IO (2002) Pathological prognostic factors in breast cancer. I: the value of histological grade in breast cancer: experience from a large study with long-term follow-up. Histopathology 41(3A):154–161CrossRefPubMed

17.

Park EH, Min SY, Kim Z, Yoon CS, Jung KW, Nam SJ, Oh SJ, Lee S, Park BW, Lim W, Hur MH, Korean Korean Breast Cancer S (2017) Basic facts of breast cancer in Korea in 2014: the 10-year overall survival progress. J Breast Cancer 20(1):1–11. https://doi.org/10.4048/jbc.2017.20.1.1 CrossRefPubMedPubMedCentral

18.

Kang SY, Kim YS, Kim Z, Kim HY, Lee SK, Jung KW, Youn HJ, Soc KBC (2018) Basic findings regarding breast cancer in Korea in 2015: data from a breast cancer registry. J Breast Cancer 21(1):1–10. https://doi.org/10.4048/jbc.2018.21.1.1 CrossRefPubMedPubMedCentral

19.

Hammond MEH, Hayes DF, Dowsett M, Allred DC, Hagerty KL, Badve S, Fitzgibbons PL, Francis G, Goldstein NS, Hayes M, Hicks DG, Lester S, Love R, Mangu PB, McShane L, Miller K, Osborne CK, Paik S, Perlmutter J, Rhodes A, Sasano H, Schwartz JN, Sweep FCG, Taube S, Torlakovic EE, Valenstein P, Viale G, Visscher D, Wheeler T, Williams RB, Wittliff JL, Wolff AC (2010) American society of clinical oncology/college of American pathologists guideline recommendations for immunohistochemical testing of estrogen and progesterone receptors in breast cancer. Arch Pathol Lab Med 134(6):907–922PubMedPubMedCentral

20.

Diab SG, Clark GM, Osborne CK, Libby A, Allred DC, Elledge RM (1999) Tumor characteristics and clinical outcome of tubular and mucinous breast carcinomas. J Clin Oncol 17(5):1442–1448. https://doi.org/10.1200/JCO.1999.17.5.1442 CrossRefPubMed

21.

Northridge ME, Rhoads GG, Wartenberg D, Koffman D (1997) The importance of histologic type on breast cancer survival. J Clin Epidemiol 50(3):283–290CrossRefPubMed

22.

Lei L, Yu X, Chen B, Chen Z, Wang X (2016) Clinicopathological characteristics of mucinous breast cancer: a retrospective analysis of a 10-year study. PLoS ONE 11(5):e0155132. https://doi.org/10.1371/journal.pone.0155132 CrossRefPubMedPubMedCentral

23.

Wei YN, Liu S, Zhang ML, Ke XX, Chen M, Wei B (2019) Clinicopathologic characteristics of HER2-positive pure mucinous breast carcinoma: a systematic investigation into an unusual tumor. Int J Clin Exp Patho 12(5):1666–1677

24.

Rasmussen BB (1985) Human mucinous breast carcinomas and their lymph-node metastases—a histological review of 247 cases. Pathol Res Pract 180(4):377–382CrossRefPubMed

25.

Baretta Z, Guindalini RS, Khramtsova G, Olopade OI (2013) Resistance to trastuzumab in HER2-positive mucinous invasive ductal breast carcinoma. Clin Breast Cancer 13(2):156–158. https://doi.org/10.1016/j.clbc.2012.11.007 CrossRefPubMed

26.

Hernandez IG, Marcos MC, Montemayor MG, Sotomayor DL, Ochoa DP, Macias GSG (2018) Her-2 positive mucinous carcinoma breast cancer, case report. Int J Surg Case Rep 42:242–246. https://doi.org/10.1016/j.ijscr.2017.12.025 CrossRef

27.

Jang Y, Cho EY, Cho SY (2019) Human epidermal growth factor receptor 2-positive mucinous carcinoma with signet ring cell differentiation, which showed complete response after neoadjuvant chemotherapy. J Breast Cancer 22(2):336–340. https://doi.org/10.4048/jbc.2019.22.e17 CrossRefPubMedPubMedCentral

Title: The prognostic value of HER2 status and efficacy of anti-HER2 therapy in patients with HR-positive mucinous breast cancer: a nationwide study from the Korean Breast Cancer Society
Authors: Hyung Suk Kim
Tae Kyung Yoo
Woo Chan Park
Byung Joo Chae
Publication date: 01-04-2020
Publisher: Springer US
Keywords: Breast Cancer
Breast Cancer
Trastuzumab
Published in: Breast Cancer Research and Treatment / Issue 2/2020
Print ISSN: 0167-6806
Electronic ISSN: 1573-7217
DOI: https://doi.org/10.1007/s10549-020-05550-4

Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras

Prof. Fabrice Barlesi

Developed by: Springer Medicine

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 2/2020

Quantitative digital imaging analysis of HER2 immunohistochemistry predicts the response to anti-HER2 neoadjuvant chemotherapy in HER2-positive breast carcinoma

Male breast cancer: a closer look at patient and tumor characteristics and factors that affect survival using the National Cancer Database

Three-dimensional microanatomy of human nipple visualized by X-ray dark-field computed tomography

Management of brain metastases in breast cancer: a review of current practices and emerging treatments

High risk of breast cancer in women with biallelic pathogenic variants in CHEK2

The role of Micro-CT in imaging breast cancer specimens

Keynote webinar | Spotlight on antibody–drug conjugates in cancer