{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T17:33:30Z","timestamp":1788024810666,"version":"build-2784847793"},"reference-count":31,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T00:00:00Z","timestamp":1768953600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T00:00:00Z","timestamp":1768953600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["acsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer"],"published-print":{"date-parts":[[2026,2,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The prognostic relevance of HER2\u2010low, HER2\u2010ultralow, and null status in HER2\u2010negative early breast cancer (eBC), and its evolution during neoadjuvant chemotherapy (NAC), remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The authors analyzed 810 HER2\u2010negative eBC patients (2011\u20132021) with centrally confirmed pre\u2010 and post\u2010NAC HER2 status. Pathologic complete response (pCR, ypT0\/is ypN0) rates were analyzed using logistic regression, and invasive disease\u2010free survival (iDFS) and overall survival (OS) were evaluated via multivariable Cox proportional hazards models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      HER2\u2010null tumors demonstrated significantly higher rates of hormone receptor negativity, grade III histology, and Ki\u201067\u00a0\u226520% compared to HER2\u2010low subgroup (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a0.05 for all). The pCR rates were 8.4% (HER2\u2010low), 20.4% (HER2\u2010ultralow), and 25.0% (HER2\u2010null), respectively. HER2 expression inversely correlated with pCR rates across the entire cohort (odds ratio, 0.75; 95% confidence interval [CI], 0.58\u20130.98;\n                      <jats:italic>p<\/jats:italic>\n                      for trend\u00a0=\u00a0.033). After a median follow\u2010up of 70.8 months, survival analysis indicated that higher HER2 expression was associated with significantly improved iDFS (hazard ratio, 0.72; 95% CI, 0.62\u20130.83) and OS (hazard ratio, 0.67; 95% CI, 0.57\u20130.80) in the overall population (\n                      <jats:italic>p<\/jats:italic>\n                      for trend &lt;.001 for both). Following NAC, nearly 41.0% of baseline HER2\u2010null tumors converted to HER2\u2010low or ultralow status. Notably, post\u2010NAC HER2 status remained predictive of improved survival in patients with residual disease (iDFS, hazard ratio, 0.72; 95% CI, 0.62\u20130.84; OS, hazard ratio, 0.65; 95% CI, 0.55\u20130.78;\n                      <jats:italic>p<\/jats:italic>\n                      for trend &lt;.001 for both).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>HER2 expression levels (low\/ultralow\/null) stratify prognosis in HER2\u2010negative eBC. The dynamic evolution of HER2 status following NAC and its prognostic utility highlights the importance of reassessing HER2 status in residual disease in HER2\u2010negative eBC.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cncr.70269","type":"journal-article","created":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T13:22:56Z","timestamp":1769001776000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["The evolution and prognostic impact of HER2\u2010low, HER2\u2010ultralow, and HER2\u2010null status in HER2\u2010negative early breast cancer: A pre\u2013 to post\u2013neoadjuvant chemotherapy study"],"prefix":"10.1002","volume":"132","author":[{"given":"Yibin","family":"Qiu","sequence":"first","affiliation":[{"name":"Department of Breast Surgery Fujian Medical University Union Hospital  Fuzhou Fujian China"},{"name":"Department of General Surgery Fujian Medical University Union Hospital  Fuzhou 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