ArticleBreast cancer research and treatment2023
Is HER2 ultra-low breast cancer different from HER2 null or HER2 low breast cancer? A study of 1363 patients.
Article in Breast cancer research and treatment, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 38 papers.
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Who cites it
38 citing papers in PubMed, 43 citations in OpenAlex.
- Revisiting HER2-negative breast cancer in the era of HER2-low and HER2-ultralow expression: Assessment of interobserver variability.Breast (Edinburgh, Scotland) · 2026Article
- HER2-low metastatic breast cancers: clinic-pathological characteristics, metastatic sites, and survival impact on biomarker discordance.Virchows Archiv : an international journal of pathology · 2026Article
- Diagnostic reproducibility, spatial heterogeneity, and survival outcomes of HER2-Null, HER2-Ultralow, and HER2-Low categories in invasive breast carcinoma.Virchows Archiv : an international journal of pathology · 2026Article
- Deep learning-based assessment of HER2-ultralow expression in breast cancer: a multi-center validation study across primary and metastatic lesions.Virchows Archiv : an international journal of pathology · 2026Article
- Survival Outcomes in ERBB2-Low vs ERBB2-Null Advanced Gastric Cancer.JAMA network open · 2026Observational
- Clinical presentations and prognostication of HER2-low and HER2-zero early breast cancer in Taiwan.Journal of the Chinese Medical Association : JCMA · 2026Article
- Repurposing HER2 IHC: Pan-HER2 and Low-HER2.Applied immunohistochemistry & molecular morphology : AIMM · 2026Review
- Comparison of Stromal Tumor-Infiltrating Lymphocyte (sTIL) Levels and Clinicopathological Features in Neoadjuvant-Naive HER2-Low and HER2-Negative Primary Breast Cancers.Medicina (Kaunas, Lithuania) · 2026Article
- Differences in Responses to Neoadjuvant Anti-HER2 Therapy between HER2 2+/ISH+ and HER2 3+ in HER2-Positive Breast Cancer.Cancer research and treatment · 2026Article
- Addressing the Challenges in the Identification of HER2-Low and Ultralow Breast Cancer in Asia: A Delphi Consensus.Advances in therapy · 2026Article
- Elucidating the relationship between affinity and potency in the performance of therapeutic IgE.Scientific reports · 2026Article
- Exploring the spectrum of HER2 in non-metastatic triple negative breast cancer: from HER2-Null to HER2-low, including HER2-ultralow status.Virchows Archiv : an international journal of pathology · 2026Article
- Prevalence of HER2-ultralow breast cancer in South Korea: a multicenter study by reassessment of HER2-zero cases.Journal of pathology and translational medicine · 2026Article
- Spatial single-cell multi-omics characterization of the tumor microenvironment heterogeneity by HER-2 expression status in gastric cancer.Molecular cancer · 2026Article
- HER2-Low Breast Cancer: Biological Framework and Determinants of HER2 Instability.Medicina (Kaunas, Lithuania) · 2026Review
- HER2-Ultralow: Prevalence, Characteristics, and Treatment Choices Among Advanced Breast Cancer Patients With Tumors Initially Scored as IHC 0.The breast journal · 2026Article
- Redefining HER2 in Breast Cancer: From Conventional Positivity to Low and Ultralow in the New Era of Antibody-Drug Conjugates.Cancer research and treatment · 2026Review
- HER2-Low and HER2-Ultralow Metastatic Breast Cancer and Trastuzumab Deruxtecan: Common Clinical Questions and Answers.Cancers · 2025Review
- Illuminating the clinicopathological and genomic landscape of HER2-null, ultralow, and low breast cancers: insights into diagnostic discordance between biopsy and surgical excision.NPJ breast cancer · 2025Article
- Emerging Breast Cancer Subpopulations: Functional Heterogeneity Beyond the Classical Subtypes.International journal of molecular sciences · 2025Review
Corrections and comments
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Authors and funding
10 authors at 2 institutions in 2 countries.
Funding
Abstract
objectiveThis study aims to analyze whether there are any differences in clinicopathological features and prognosis between HER2 ultra-low, HER2-null, and HER2-low expression in Chinese breast cancer (BC) patients.
methodsThe clinicopathological data of 1363 HER2-negative BC patients were retrospectively collected (from January 2018 to December 2019). HER2 status was further classified into HER2-null, HER2 ultra-low, and HER2-low. HER2-null expression is defined as infiltrating cancer cells completely free of staining. HER2 ultra-low expression is defined as ≤10% of infiltrating cancer cells showing incomplete and faint/weak membrane staining. HER2-low expression is defined as HER2 immunohistochemistry (IHC) 1+ or 2+ with negative in situ hybridization (ISH) assay.
resultsOf 1363 patients, there were 86 (6.3%) HER2-null patients, 395 (29.0%) HER2 ultra-low patients, and 882 (64.7%) HER2-low patients. HER2 ultra-low patients were different from HER2-low patients in terms of N stage, hormone receptor (HR) status, Ki-67 expression, and type of surgery. There were also significant differences in histologic type and postoperative endocrine therapy between HER2 ultra-low and HER2-null patients. HR+ (81.0%) tumors was more common than HR- (19.0%) in HER2 ultra-low patients. In addition, there was a significant difference in HR status between HER2 ultra-low and HER2-low patients (P = 0.001). The survival analysis showed that HER2 status had no effect on disease-free survival (DFS) in HER2-negative patients (all P > 0.05). However, regardless of HER2 status, HR+ patients had better DFS than HR- patients (P = 0.003). Cox multivariate analysis revealed that age (HR [95% CI] = 0.950 [0.928, 0.972], P < 0.001), HR status (HR [95% CI] = 3.342 [1.658, 6.736], P = 0.001), and postoperative endocrine therapy (HR [95% CI] = 0.048 [0.048, 0.023], P < 0.001) were important influencing factors of DFS in HER2-negative BC patients.
conclusionHER2 ultra-low BC patients demonstrated distinct clinicopathological features from HER2-null and HER2-low tumors; while, HER2 status (null, ultra-low, or low) had no prognostic value in these HER2-negative BC population. Consistent with the published literature, HR status was an independent prognostic factor for DFS in HER2-negative BC patients.
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