| In 2021,the International Agency for Research on Cancer released a global cancer statistics report based on the GLOBOCAN 2020 database.After calculating the incidence and death of 36 types of cancer in 185 countries around the world,the latest cancer burden shows that breast cancer has become the most common cancer in the world,with 2.3 million new cases.It accounts for 11.7%of all new cases and 685,000deaths,making it the fifth leading cause of cancer death worldwide.If current trends continue,breast cancer will increase to over 3 million new cases and over 1 million deaths per year by 2040[1,2].With the global incidence of breast cancer increasing year by year,precision therapy based on molecular typing has gradually attracted the attention of doctors.The use of more refined molecular typing will further improve the therapeutic effect of breast cancer and improve the prognosis of patients.Objective:To explore the correlation of Human Epidermal Growth Factor Receptor 2 low expression（HER-2 low）with clinicopathologic features of HR-positive breast cancer and risk of axillary lymph node metastasis.This paper establishes a Nomogram model to predict axillary lymph node metastasis by using several confirmed independent risk factors.Method:The data of 899 patients with HR-positive breast cancer with HER-2 IHC 0 or low HER-2 expression admitted to the Breast surgery ward of China-Japan Friendship Hospital of Jilin University from October 2017 to December 2021 were collected.All cases had complete clinical and pathological data,including age,height,weight,menstrual status,T stage,tumor site,Lymph node status and Estrogen Receptor（ER）and Progesterone Receptor（PR）while other Immunohistochemistry（IHC）results.According to immunohistochemistry and Fluorescence In Situ Hybridization（FISH）,the included cases were divided into HER-2 IHC 0 group,HER-2 IHC 1+group and HER-2 IHC 2+group FISH（-）.SPSS26.0 was used for statistical analysis to explore the pathological features and axillary lymph node metastasis of each group.Chi-square analysis was used for inter-group testing,Bonferroni method was used for multiple comparisons,and Logistic regression and Propensity Score Matching（PSM）were a lot of risk factors for axillary lymph node metastasis.And a Nomogram prediction model was established by R4.2.2 to predict the risk of axillary lymph node metastasis.P<0.05was considered statistically significant,and 95%was considered as the confidence interval.Result:During the study,375 cases were included in the HER-2 IHC 0 group,and 524cases were included in the low HER-2 expression group（315 cases in the HER-2 IHC1+group and 209 cases in the HER-2 IHC 2+group with FISH（-））.There were significant differences in age,tumor site and Ki67 distribution among all groups（P<0.05）.The results of multivariate Logistic regression analysis showed that T stage,BMI and HER-2 expression were statistically significant（P<0.05）,which were independent risk factors for axillary lymph node metastasis of HR-positive breast cancer.The results of propensity score matching analysis were also calibrated to confirm this conclusion.Among them,BMI（OR=1.744,P=0.001）and T stage（OR=3.504,P<0.001）.The expression status of HER-2 was a triplex variable in this study.After the dummy variable was set with group HER-2 IHC 0 as the control group,HER-2 IHC 1+（OR=2.214,P<0.001）and HER-2 IHC 2+/FISH（-）（OR=6.438,P<0.001）were obtained.Finally,the Nomogram model was established based on the above independent risk factors and verified to be valuable for predicting the risk of axillary lymph node metastasis of HR-positive breast cancer.Conclusion:1.In HR-positive breast cancer,HER-2 IHC 0 type and low HER-2 expression type have statistical differences in age,tumor site and distribution of Ki67.2.In HR-positive breast cancer,tumor size,BMI,and low HER-2 expression are independent risk factors for axillary lymph node metastasis.3.In HR-positive breast cancer,low expression of HER-2 can act as a positive predictor of axillary lymph node metastasis. |
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