Pathological response to neoadjuvant chemotherapy and survival in patients with breast cancer: A multicentric retrospective study

In several European and American countries, pathological complete response (pCR) to neoadjuvant chemotherapy (NAC) in breast cancer has been identified as a predictor of improved survival. However, data from Black African patients are lacking. The present study aimed to evaluate the pathological response to NAC and its impact on survival in patients with breast cancer. A retrospective analysis of patients with breast cancer treated with NAC from January 2017 to December 2024 (96 months) was performed to assess associations between clinicopathological variables and pCR using a binary logistic regression test. Survival rates were determined using the Kaplan-Meier method. Survival comparisons in univariate analysis were performed using the log-rank test. A Cox regression model was used for multivariate analysis. The mean age of the 195 included patients was 46.3 years. The predominant histological type was invasive carcinoma of no special type (91.3%). Stage III tumors accounted for 69.8% of cases. The molecular subtypes were: Luminal (39.5%), HER2-positive (20.5%) and triple-negative (TN; 40.0%). NAC consisted primarily of sequential anthracycline-taxane regimens (94.4%). pCR was achieved in 28.7% of cases. HER2-positive tumors were significantly associated with pCR (odds ratio, 2.62; 95% CI, 1.10-6.22). Multivariate analysis revealed that pCR was the only factor significantly associated with both progression-free survival [PFS; hazard ratio (HR), 6.54] and overall survival (OS; HR, 5.84;. Within each molecular subtype, pCR was associated with improved PFS. In the TN group only, pCR was associated with improved OS. Pathological response was the strongest independent predictor of improved PFS and OS. HER2-positive tumors demonstrated the highest probability of pCR, while only the TN subtype showed a significant improvement in both OS and PFS with the achievement of pCR.