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Clinical Implication of HER2 Status in Hormone Receptor-Positive Mucinous Breast Cancer

Sung-chan Gwark MD, PhD, Han Shin Lee MD, Youngjoo Lee MD, Sae Byul Lee MD, PhD, Guiyun Sohn MD, Jisun Kim MD, PhD, Il Yong Chung MD, Beom Seok Ko MD, PhD, Hee Jeong Kim MD, PhD, Byung Ho Son MD, PhD, Jin-Hee Ahn MD, PhD, Kyung Hae Jung MD, PhD, Sung-Bae Kim MD, PhD, Hee Jin Lee MD, PhD, Gyung-Yub Gong MD, PhD, Sei Hyun Ahn MD, PhD, Jong Won Lee MD, PhD
Breast Oncology
Volume 26, Issue 7 / July , 2019

Abstract

Purpose

Mucinous carcinoma (MC) is a rare breast cancer with favorable outcome. Unlike typical breast cancer, the current guidelines do not recommend chemotherapy or anti-human epidermal growth factor receptor 2 (HER2) therapy for hormone receptor (HR)-positive MC, regardless of HER2 status. We evaluated the prognostic implication of HER2 status in HR-positive MC.

Methods

We retrospectively reviewed the data of 471 patients with pure MC (stages I–III) who underwent curative surgery. We analyzed 5-year disease-free survival (DFS) and distant metastasis-free survival (DMFS), according to clinicopathological characteristics.

Results

The median follow-up duration was 79.0 months. Overall, the 5-year DFS rate was 95.7% and the 5-year DMFS rate was 96.2%. Nodal status was the only significant factor for DFS (relative risk [RR], 3.40; 95% confidence interval [CI] 3.40–9.67, p = 0.021). Among HR-positive/node-negative patients with tumor size ≥ 3 cm, HER2-positive patients showed significantly worse DFS (RR, 8.76; 95% CI 1.45–52.76, p = 0.018) and DMFS (RR, 11.37; 95% CI 1.37–74.70, p = 0.011). This finding was consistently significant, when combining both “HR-positive/node-negative/tumor size ≥ 3 cm” and “HR-positive/node-positive” MC (n = 125) for DFS (RR, 4.30; 95% CI 1.43–12.97, p = 0.009) and DMFS (RR, 4.93; 95% CI 1.63–14.90, p = 0.005). Intriguingly, within this subgroup, among HER2-positive tumors, whereas 5-year DFS was 60.2% in patients who did not receive trastuzumab, 100% of those who received trastuzumab were disease free (p = 0.053).

Conclusions

In HR-positive, node-negative MC with tumor size ≥ 3 cm, patients with HER2-positive MC showed worse survival, suggesting a potential role of an anti-HER2 strategy in this subgroup.

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