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Abstract：
Previously, we found that patients with estrogen receptor (ER)-positive, HER2-low breast cancer are resistant to neoadjuvant chemotherapy (NACT) and have worse outcomes than those who achieve pathological complete response (pCR) after NACT. This study aimed to investigate the prognosis and influencing factors in these patients. A total of 618 patients with ER-positive breast cancer who received standard thrice-weekly NACT were enrolled, including 411 patients with ER-positive, HER2-low breast cancer. Data on the clinicopathological features of these patients before and after NACT were collected. Univariate and multivariate Cox regression analyses were used to identify the independent factors affecting 5-year disease-free survival (DFS). Among the ER-positive, HER2-low patients, 49 (11.9%) achieved a pCR after NACT. A significant difference in survival was observed between patients with and without residual disease after NACT. Additionally, changes in immunohistochemical markers and tumor stages before and after NACT were found to be significant. According to univariate and multivariate analyses, cN_stage (P = 0.002), ER (P = 0.002) and Ki67 (P = 0.023) expression before NACT were significantly associated with 5-year DFS, while pT_stage (P = 0.015), pN_stage (P = 0.029), ER (P = 0.020) and Ki67 (P < 0.001) levels after NACT were related to 5-year DFS in ER-positive, HER2-low patients with residual disease. Our study suggested that high proliferation, low ER expression and advanced stage before and after NACT are associated with a poor prognosis, providing useful information for developing long-term treatment strategies for ER-positive, HER2-low breast cancer in patients with residual disease in the future.
摘要：
以前,我们发现雌激素受体（ER）阳性的患者，低HER2乳腺癌对新辅助化疗（NACT）具有抗性，并且与NACT后达到病理完全缓解（pCR）的患者相比，预后更差。本研究旨在探讨这些患者的预后及其影响因素。共纳入618例接受标准每周三次NACT的ER阳性乳腺癌患者，包括411例ER阳性患者，HER2低乳腺癌。收集NACT前后这些患者的临床病理特征数据。单因素和多因素Cox回归分析用于确定影响5年无病生存期（DFS）的独立因素。在ER阳性的人中，HER2低患者，49（11.9%）在NACT后达到pCR。NACT后有和没有残留疾病的患者之间的生存率显着差异。此外,发现NACT前后的免疫组织化学标志物和肿瘤分期的变化是显著的。根据单变量和多变量分析，cN_stage(P=0.002)，NACT前ER(P=0.002)和Ki67(P=0.023)的表达与5年DFS显著相关。而pT_stage(P=0.015)，pN_stage(P=0.029)，NACT后的ER（P=0.020）和Ki67（P<0.001）水平与ER阳性的5年DFS相关。低HER2患者残留疾病。我们的研究表明，高增殖，ER低表达和NACT前后的晚期与不良预后相关，为制定ER阳性的长期治疗策略提供有用的信息，低HER2乳腺癌患者残留病变的未来
