Predictive value of ALBI score and age for developing resistance to trastuzumab in HER-2-positive breast cancer patients: prediction based on a real-world case series from a single center in China

Objective To assess the clinical value of the ALBI score and age in predicting trastuzumab resistance in patients with HER-2 positive breast cancer (BC). Methods A retrospective cohort study was conducted on patients with HER-2 positive BC treated with trastuzumab at the Department of Thyroid and Breast Surgery of Affiliated Hospital of Shandong University of Traditional Chinese Medicine from December 2017 to December 2023. Patients were divided into a resistance group and a non-resistance group based on the development of resistance after trastuzumab treatment. Multivariate logistic regression models were used to identify independent predictors of trastuzumab resistance, and ROC curves analysis was conducted to evaluate the predictive value of ALBI score and patients age. Results This study included 95 female patients with HER-2 positive BC treated with trastuzumab, aged 31–71 years (mean age 53.15 ± 10.063 years). Based on the development of resistance after trastuzumab treatment, patients were divided into a resistant group (11 cases, 11.6%) and a non-resistant group (84 cases, 88.4%). Compared with the non-resistant group, the resistant group showed significantly higher age, ALBI score, and carcinoembryonic antigen (CEA) levels ( P < 0.05 ). Both ALBI score ( OR = 0.113, 95% CI: 0.014–0.904 ) and age ( OR = 0.935, 95% CI: 0.875–1.000 ) were independent predictors of trastuzumab resistance in HER2-positive BC patients. ROC curve analysis showed that the combination of age and ALBI score predicted resistance with an AUC of 0.771 ( 95% CI: 0.642–0.900 ), sensitivity of 72.7%, and specificity of 77.4%, demonstrating significantly superior predictive performance compared to ALBI score or age alone. Conclusion Both ALBI score and age are independent predictors influencing trastuzumab resistance in HER-2 positive BC patients. Their combined use enhances predictive accuracy and may facilitate early identification of patients at increased risk of developing resistance to trastuzumab.