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Evaluating the impact of histological vs. nuclear grading on CPS + EG Score for HR + /HER2-early breast cancer
M Braun1, M Hamann2, C Hanusch2
1Breast Cancer Center, Department of Gynecology, Red Cross Hospital Munich, Taxisstrasse 3, 80637, Munich, Germany. Michael.braun@swmbrk.de.
Purpose:
The CPS + EG score, widely used for risk assessment in high-risk HR + /HER2-early breast cancer following neoadjuvant chemotherapy (NAC), integrates clinical and pathological staging, estrogen receptor status, and nuclear grading (nG). However, histological grading (hG) is often used in clinical practice due to better availability. This study aims to assess the concordance between nG and hG and examine their impact on CPS + EG scores.
Methods:
A retrospective analysis was conducted at the Red Cross Hospital Munich with two cohorts. Cohort 1 included 610 consecutively treated patients in 2022 to evaluate the concordance of nG and hG scores. Cohort 2 involved 106 high-risk patients treated between 2019 and 2022, comparing CPS + EG scores calculated using nG versus hG values.
Results:
In Cohort 1, nG and hG were discordant in 31.2% of cases, with nG3 classifications outnumbering hG3. Cohort 2 showed a similar discordance rate of 33.0%, with more tumors classified as nG3 (52.8%) than hG3 (36.8%). Among non-pCR patients, a CPS + EG score of ≥ 3 was found in 29.7% of cases with nG, versus 19.0% with hG, indicating hG may underestimate risk.
Conclusion:
Using hG instead of nG for CPS + EG calculations may underestimate risks related to distant metastasis-free and disease-specific survival, suggesting a potential need for nG prioritization in clinical risk assessments.
