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Can neoadjuvant systemic therapy provide additional benefits for T1 HER2+ breast cancer patients: a subgroup analysis based on different high-risk signatures

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Abstract

Introduction

Neoadjuvant systemic therapy (NAST) is vital in the management of HER2-positive (HER2+) breast cancer. Nevertheless, the indications for NAST in tumors <2 cm remain controversial.

Method

A total of 7961 patients were screened from the Surveillance, Epidemiology, and End Result database. Independent prognostic factors were identified using multivariate Cox analysis. Subgroup analyses and Kaplan–Meier analyses were used to simulate whether NAST would provide a survival benefit with different high-risk characteristics. Nomograms were constructed, and an internal validation cohort was employed.

Results

Of the 7961 included patients, 1137 (14.3%) underwent NAST. In the total population, NAST was associated with poorer overall survival (OS) and breast cancer-specific survival (BCSS) (OS: P = 0.00093; BCSS: P  <  0.0001). Multivariate Cox analysis confirmed that NAST markedly affected the prognosis of enrolled patients. Besides, a direct association between T, N, age, subtype, and prognosis was observed. Subgroup analyses yielded in these three subgroups, T1c, hormone receptor-negative, and 61–69 years of age, NAST and AST had comparable OS, while NAST possessed worse BCSS. Notably, even in the N3, we still did not observe any additional benefit of NAST. The calculated C-index of 0.72 and 0.73 confirmed the predictability of the nomograms. The AUCs exhibit consistency in the training and validation cohorts.

Conclusion

Our findings suggest that NAST does not provide additional benefit to patients with T1 HER2+ breast cancer, even in the presence of lymph node metastasis, T1c, or hormone receptor negativity. This study facilitates the implementation of individualized management strategies.

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Data availability

The Surveillance, Epidemiology and End Results (SEER)-Medicare-linked data that support the findings of this study are available from the National Cancer Institute but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available.

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Acknowledgements

We acknowledge the data support of the SEER program, as well as the Instrument Analysis Center of Xi’an Jiaotong University.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Author notes

  1. Lidan Chang and Dandan Liu contributed equally.

Authors and Affiliations

  1. Department of Oncology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, 710061, Shaanxi, China

    Lidan Chang, Dandan Liu, Xuyan Zhao, Luyao Dai, Xueting Ren, Qian Hao, Peinan Liu, Xiaobin Ma & Huafeng Kang

  2. Department of Biophysics, School of Basic Medical Sciences, Key Laboratory of Environment and Genes Related to Diseases, Xi’an Jiaotong University Health Science Center, Xi’an, 710061, Shaanxi, China

    Hao Wu

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Contributions

All authors had full access to the data in the study and took responsibility for the integrity of the data and the accuracy of the data analysis. Conceptualization, LD.C. and DD.L.; Methodology, XY.Z. and LY.D.; Investigation, XT.R., LD.C., and Q.H.; Formal Analysis, LD.C. and DD.L.; Resources, PN.L. and LY.D.; Writing—Original Draft, LD.C. and DD.L.; Writing—Review & Editing, H.W, XB.M. and HF.K.; Visualization, H.W.; Supervision, XB.M. and HF.K.; Funding Acquisition, XB.M. and HF.K.

Corresponding authors

Correspondence to Xiaobin Ma or Huafeng Kang.

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The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Declaration of generative AI in scientific writing

The authors declare that this study was conducted without any AI or AI-assisted writing and did not use any AI or AI-assisted technology.

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The authors declare that this study does not contain data from any person. Therefore, the statement of consent for publication does not apply.

Ethical approval and informed consent

This study has been approved by the Ethics Committee of The Second Affiliated Hospital of Xi'an Jiaotong University. The access to and use of SEER data did not require informed patient consent.

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Chang, L., Liu, D., Zhao, X. et al. Can neoadjuvant systemic therapy provide additional benefits for T1 HER2+ breast cancer patients: a subgroup analysis based on different high-risk signatures. Clin Transl Oncol (2024). https://doi.org/10.1007/s12094-024-03472-x

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