Oncotype Dx Score, HER2 Low Expression, and Clinical Outcomes in Early-Stage Breast Cancer: A National Cancer Database Analysis
by
Arya Mariam Roy
1,†, 
Changchuan Jiang
1,†,
Stuthi Perimbeti
1,
Lei Deng
1,
Charles L. Shapiro
2 and
Shipra Gandhi
1,* 1
Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA
2
Division of Hematology and Medical Oncology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
*
Author to whom correspondence should be addressed.
†
These authors contributed equally to this work.
Cancers 2023, 15(17), 4264; https://doi.org/10.3390/cancers15174264
Submission received: 2 August 2023
/
Revised: 19 August 2023
/
Accepted: 23 August 2023
/
Published: 25 August 2023
(This article belongs to the Section Cancer Informatics and Big Data)
Simple Summary
The relation between HER2-low status in breast cancer and the hormone receptor-positive breast cancer recurrence score—oncotype recurrence score—is not very well studied. We conducted a study to look at the utility of the oncotype recurrence score in HER2-low and HER2-zero breast cancer by using the data from the National Cancer Database. We found that the recurrence score of HER2-low breast cancer was slightly higher compared to HER2-zero breast cancer. Women with HER2-low breast cancer had better survival, especially for those with hormone receptor-negative breast cancer. Among those who received chemotherapy for breast cancer with a high recurrence score, those with HER2-low breast cancer had higher survival compared to HER2-zero breast cancer.
Abstract
Background: The interaction between HER2-low expression, oncotype recurrence score (RS), and their influence on the prognosis of HR+/HER2- breast cancer (BC) is not very well studied. Methods: We conducted a retrospective cohort study of patients diagnosed with resectable HER2-low and HER2-zero BC from the National Cancer Database. The primary outcome was overall survival (OS), and the association of RS with the clinical outcomes in HR+/HER2- BC was analyzed as an exploratory endpoint. Results: The distribution of RS was comparable between HER2-low and HER2-zero groups; however, the RSs of HER2-low tumors were more likely to be 16–25. Women with HER2-low tumors had longer 5-year OS than women with HER2-zero tumors in the HR-negative (84.3% vs. 83.9%; p < 0.001, HR: 0.87 (0.84–0.90), p < 0.001) but not in the HR-positive group (94.0% vs. 94.0%; p = 0.38, HR: 0.97 (0.95–0.99), p = 0.01). The survival advantage was observed in patients who received adjuvant/neoadjuvant chemotherapy (p-interaction (chemo vs. no chemo) < 0.001). Among those who received adjuvant chemotherapy in the group with higher RSs (26–100), those with HER2-low BC had higher 5-year OS than HER2-zero BC. Conclusions: Resectable HER2-low BC had a better prognosis than HER2-zero BC. Among those who received adjuvant chemotherapy in the higher oncotype RS group, those with HER2-low tumors had better survival.
