The Clinical Study Of Prognosis Correlation Analysis Of HER2 Low Expression Breast Cancer And Constructing Predictive Model

Objective: The purpose of this study is to analyze the relationship between clinicopathological characteristics and prognosis of HER 2 low expression breast cancer,explore its biological characteristics,provide a basis for accurate individualized treatment of patients with low expression breast cancer,and improve the survival prognosis of breast cancer patients.Methods: In this study,1147 primary breast cancer patients treated in the First Hospital of Lanzhou University from January 2016 to December 2020 were collected,and 654 breast cancer patients were selected as the study subjects,and their general clinical and pathological data were collected and survival follow-up.The clinicopathological characteristics and prognosis relationship between 2 groups of 348 patients with low HER 2 expression(1 + or 2 + and / ISH-)and 306 patients with null HER 2 expression were analyzed.Disease-free survival in both groups of patients(disease free survival,DFS)and overall survival(overall survival,OS)conduct analysis,Survival rate was calculated using the Kaplan – Meier curves,The Log-rank test comparing the survival differences,Independent factors affecting prognosis by Cox multivariate analysis,Based on the independent prognostic factors identified,Using the "rms" package of the R software(Jr,2020)established the prognostic Nomogram.The predicted efficacy was determined using the ROC curve analysis,A difference of P <0.05 was considered to be statistically significant.Results:1.Clinicopathological analysis of the two patient groups: a total of 654 patients were included,In 348 patients with low expression of HER 2,304 patients with zero expression of HER 2;Immunohistochemistry in 348 patients with low HER 2expression(Immunohistochemistry,IHC)208(59.8%),IHC2 + and in situ hybridization(in situ hybridization,ISH)--140 cases(40.2%);(1)348 patients with low HER 2 expression and 306 patients with zero HER 2 expression at age,physical fitness index(Body Mass Index,BMI),menstrual status,family history of malignancy,underlying disease,tumor location,c T stage,lymph node status,clinical TNM stage,histological type,and Ki-67 expression,However,there were significant differences in histological grade,ER expression,PR expression and molecular typing,And it was statistically significant(P<0.05);Compared with patients with zero HER 2 expression,More patients with low HER 2 expression were G2-3(P=0.047),ER positive and PR positive patients(P <0.001,P <0.001),and more proportion of Luminal patients(510vs.144,P<0.001);(2)In the HR-negative subgroup,Less menopausal patients in the low HER 2 expression group(40.0% vs.57.4%,P=0.046).2.Prognostic factors analysis:(1)among the 654 patients,The low and zero expression status of HER 2 had no significant effect on DFS and OS(P=0.227,P=0.081),However,both DFS and OS in the low HER 2 expression group were better than HER 2 zero expression;(2)In the subgroup analysis,In the 510 patients with positive HR,Low and null expression of HER 2 had no significant effect on DFS and OS(P=0.120,P=0.069),DFS and OS of HER 2 low expression group were better than HER 2 zero expression;(3)Among the 144 patients with negative HR,Both DFS and OS in the low HER 2 expression group were inferior to the HER 2 null expression group,Also statistically different in DFS(P=0.049),There was no significant difference in OS(P=0.558).3.Results of univariate analysis:(1)in all populations,The c T stage,lymph node status,clinical TNM stage,histological grade,ER expression,PR expression,Ki-67 expression and HR expression were the risk factors affecting DFS and OS in patients,in addition,Age is also a risk factor for DFS;(2)c T stage,lymph node status,and clinical TNM stage are the risk factors affecting DFS in HR positive patients,Basic disease,lymph node status,and clinical TNM stage are the risk factors affecting OS in HR positive patients;(3)c T stage,clinical TNM stage and HER 2 expression status are risk factors affecting DFS in HR negative patients,The c T stage,clinical TNM stage and histological grade were risk factors affecting OS in HR negative patients.4.The results of the Cox multivariate analysis show that:(1)in all populations,Age,clinical TNM stage,and HR expression status were independent risk factors affecting DFS in patients,Histological type,clinical TNM stage and HR expression status were independent risk factors affecting the OS of patients;(2)In the HR-positive subgroup of patients,Age,clinical TNM stage and histological type were independent risk factors for DFS in patients,Age,underlying disease,histological type,and HER 2 expression status were independent risk factors influencing the OS of patients;(3)In the subgroup of HR-negative patients,Clinical TNM stage and HER2 expression status were independent risk factors affecting DFS in patients,Clinical TNM stage is an independent risk factor for the OS of patients.5.Based on the multivariate results,the nomogram prediction model of the 5-year overall survival of HR positive breast cancer was verified.The ROC curve analysis showed that the nomogram prediction model predicted the area under the curve(AUC)affecting the OS factors of HR positive breast cancer was 0.718(95% CI:0.603-0.833),the sensitivity was 94.4% and the specificity was 40.4%.Conclusions:1.In the total population,low expression of HER 2 has a better prognosis than patients with zero HER 2 expression,and low expression of HER 2 is likely to become an independent molecular subtype,but further research is still needed;2.Low expression of HER 2 was more prevalent in HR positive patients than HER 2 zero expression(78.0% vs.22.0%),with longer DFS and OS and better prognosis.3 Low HER 2 expression has a worse prognosis than HER 2 null expression in HR negative patients.