http://www.nature.com/bjc/journal/v1.../6605799a.html
Clinical Study
British Journal of Cancer (2010) 103, 475–481. doi:10.1038/sj.bjc.6605799
www.bjcancer.com
Published online 27 July 2010
Increased mortality in HER2 positive, oestrogen receptor positive invasive breast cancer: a population-based study
C A Purdie1, L Baker2, A Ashfield2, S Chatterjee3, L B Jordan1, P Quinlan2, D J A Adamson3, J A Dewar3 and A M Thompson2
1Department of Pathology, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK
2Department of Surgery and Molecular Oncology, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
3Department of Clinical Oncology, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK
Correspondence: Dr CA Purdie, E-mail:colin.purdie@nhs.net
Received 31 March 2010; Revised 18 June 2010; Accepted 18 June 2010; Published online 27 July 2010.
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Abstract
background: This study assessed the impact of human epidermal growth factor receptor 2 (HER2) status on the outcomes in an unselected population of breast cancer patients who did not receive HER2-targeted therapy.
methods: HER2 status by immunohistochemistry and fluorescence in situ hybridisation was compared with clinicopathological data, overall survival (OS) and disease-free survival (DFS) for all patients presenting with breast cancer over 3 years.
results: In 865 patients (median follow up 6.02 years), HER2 positivity was identified in 13.3% of all cancers and was associated with higher tumour grade (P<10−8), lymphovascular invasion (P<0.001) and axillary nodal metastasis (P=0.003). There was a negative association with oestrogen-receptor (ER) and progesterone-receptor expression (P<10−8), but the majority (57%) of HER2+tumours were ER+HER2 positivity was associated with poorer OS (P=0.0046) and DFS (P=0.0001) confined to the lymph node-positive (LN+) and ER+ subgroups.
conclusion: HER2-positive cancers were less common in this population-based cohort than most selected series. The association of HER2 positivity with poor prognosis was confined to the ER+ and LN+ subgroups. The survival deficit for the 7.5% of patients with ER+/HER2+ cancer compared with ER+/HER2– patients points to a significant subgroup of women who may not (currently) be considered for HER2-directed therapy.
Keywords: breast cancer; oestrogen receptor; HER2; survival; population
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