Correlation of Clinical and Immunological Factors With Overall Survival in Luminal B HER2-Negative Breast Cancer Patients at Prof. Dr. I.G.N.G. Ngoerah Hospital, Denpasar
DOI:
https://doi.org/10.26555/eshr.v8i1.14936Keywords:
Breast cancer, HER2-negative, Luminal B, Prognostic factor, SurvivalAbstract
Background: This study aimed to explore the relationship between clinico-pathological characteristics and overall survival (OS) among patients with Luminal B HER2-negative breast cancer treated at Prof. Dr. I.G.N.G Ngoerah Hospital, Denpasar.
Method: A retrospective cohort study was conducted involving 248 patients diagnosed with Luminal B HER2-negative breast cancer between January 2018 and December 2022. Data were collected from medical records and the Bali Cancer Registry, including variables such as age, menopausal status, tumor size (T), nodal involvement (N), metastasis (M), lymphovascular invasion (LVI), tumor-infiltrating lymphocytes (TIL), and treatment modalities. OS was analyzed using the Kaplan–Meier method, and independent prognostic factors were identified through multivariate Cox proportional hazards regression.
Results: Most patients were aged ≥40 years (84.8%), premenopausal (58.1%), and had LVI-positive tumors (65.9%). The 5-year OS rate was 60.8%, with a mean survival of 48 months. Kaplan–Meier analysis demonstrated shorter survival among older and postmenopausal patients. In multivariate analysis, TIL (HR = 0.342; 95% CI = 0.171–0.684; p < 0.001), age ≥40 years (HR = 1.459; 95% CI = 1.233–1.875; p < 0.001), and postmenopausal status (HR = 4.553; 95% CI = 2.378–8.733; p < 0.001) were identified as independent predictors of poorer survival.
Conclusion: These findings underscore the prognostic importance of immunological and demographic factors in Luminal B HER2-negative breast cancer. The assessment of tumor-infiltrating lymphocytes may serve as a practical and feasible prognostic marker to support risk stratification and individualized management, particularly in resource-limited healthcare settings, while highlighting the need for strengthened early detection and follow-up strategies among older and postmenopausal women.
References
Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2024;74(3):229–63.
Smolarz B, Zadrożna Nowak A, Romanowicz H. Breast Cancer—Epidemiology, Classification, Pathogenesis and Treatment (Review of Literature). Vol. 14, Cancers. MDPI. 2022;14(10):2569. Doi: 10.3390/cancers14102569
Li P, Yuan W, Wu R, Zeng C, Li K, Lu L. Androgens in Patients With Luminal B and HER2 Breast Cancer Might Be a Biomarker Promoting Anti-Pd-1 Efficacy. Front Oncol. 2022;12.
Rajc J. Prognostic Impact of Low Estrogen and Progesterone Positivity in Luminal B (HER2 Negative) Breast Cancer. Acta Clin Croat. 2018;
Park C, Park K, Kim J, Sin Y, Park I, Cho H, et al. Prognostic Values of Negative Estrogen or Progesterone Receptor Expression in Patients With Luminal B HER2-negative Breast Cancer. World J Surg Oncol. 2016;14(1).
Berkel C, Cacan E. Estrogen- and estrogen receptor (ER)-mediated cisplatin chemoresistance in cancer. Life Sci [Internet]. 2021;286:120029. Doi: 10.1016/j.lfs.2021.120029
Lammers SWM, Geurts SME, Hermans KEPE, Kooreman LFS, Swinkels ACP, Smorenburg CH, et al. The prognostic and predictive value of the luminal-like subtype in hormone receptor-positive breast cancer: an analysis of the DATA trial. ESMO Open. 2025;10(2).
Sereda EE, Kolegova ES, Kakurina G V., Korshunov DA, Sidenko EA, Doroshenko A V., et al. Five-year survival in luminal breast cancer patients: relation with intratumoral activity of proteasomes. Translational Breast Cancer Research. 2022;3.
Díaz S, Castilla-Tarra JA, Torres EP, Orozco-Ospino M, Mendoza-Díaz S, Nuñez‐Lemus M, et al. Pathological Response to Neoadjuvant Chemotherapy and the Molecular Classification of Locally Advanced Breast Cancer in a Latin American Cohort. Oncologist. 2019;24(12):e1360–70.
Lee Y, Park I, Cho H, Yang K, Kim J, Park K, et al. Prognostic Value of Estrogen and Progesterone Receptor Expression in Low Proliferative Human Epidermal Growth Factor Receptor 2-Negative Breast Cancer. Journal of Breast Disease. 2017;5(2):64–70.
Łukasiewicz S, Czeczelewski M, Forma A, Baj J, Sitarz R, Stanisławek A. Breast cancer—epidemiology, risk factors, classification, prognostic markers, and current treatment strategies—An updated review. Vol. 13, Cancers. MDPI; 2021; 13(17):4287. doi: 10.3390/cancers13174287.
Marinovich ML, Wylie E, Lotter W, Lund H, Waddell A, Madeley C, et al. Artificial intelligence (AI) for breast cancer screening: BreastScreen population-based cohort study of cancer detection. EBioMedicine. 2023;90:104498. doi: 10.1016/j.ebiom.2023.104498
Shien T, Iwata H. Adjuvant and neoadjuvant therapy for breast cancer. Jpn J Clin Oncol. 2020;50(3):225–9.
Stanton SE, Disis ML. Clinical significance of tumor-infiltrating lymphocytes in breast cancer. J Immunother Cancer. 2016;4:59.
Aydin AM, Hall M, Bunch BL, Branthoover H, Sannasardo Z, Mackay A, et al. Expansion of tumor-infiltrating lymphocytes (TIL) from penile cancer patients. Int Immunopharmacol. 2021;94.
Sudarsa IW, Aryanti C. Duration of Tumor-infiltrating Lymphocytes Assessment with Significant Overall Survival Prognostic Value in Locally Advanced Breast Cancer. Open Access Maced J Med Sci. 2022;10(B):124–8.
Fernandes I, Scorsato A, Kaliks R, Corpa M, Damasceno E, Schvartsman G. Tumor-Infiltrating Lymphocytes in HER2-Low Breast Cancer. Clin Breast Cancer. 2023;23(7):e470–9.
Houvenaeghel G, Cohen M, Classe JM, Reyal F, Mazouni C, Chopin N, et al. Lymphovascular invasion has a significant prognostic impact in patients with early breast cancer, results from a large, national, multicenter, retrospective cohort study. ESMO Open. 2021;6(6).
Çavdar E, İriağaç Y. Predictors of lymphovascular invasion in estrogen receptor positive/Her-2 negative breast cancer patients treated with neoadjuvant chemotherapy. Turk J Med Sci. 2022;52(4):1111–7.
Yerushalmi R, Woods R, Ravdin PM, Hayes MM, Gelmon KA. Ki67 in breast cancer: prognostic and predictive potential. Lancet Oncol [Internet]. 2010;11(2):174–83. Doi: 10.1016/s1470-2045(09)70262-1
Kanyılmaz G, Yavuz BB, Aktan M, Karaağaç M, Uyar M, Fındık S. Prognostic Importance of Ki-67 in Breast Cancer and Its Relationship with Other Prognostic Factors. Eur J Breast Health. 2019;15(4):256–61. Doi: 10.5152/ejbh.2019.4778
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