Prognostic but not predictive: the clinical implications of androgen receptor expression in breast cancer patients undergoing neoadjuvant chemotherapy

Background The androgen receptor (AR) is a potential biomarker in breast cancer (BC), but its predictive and prognostic value—especially regarding neoadjuvant chemotherapy (NAC) response—remains unclear. This study evaluates the relationship between pre-treatment AR expression and both therapeutic response and survival outcomes.Methods A retrospective multicenter cohort of 194 BC patients treated with NAC was analyzed. AR expression was assessed by immunohistochemistry on pretreatment core biopsy samples. Associations between AR expression and clinicopathologic variables, pathological complete response (pCR), disease-free survival (DFS), and overall survival (OS) were statistically evaluated.Results AR expression was significantly associated with hormone receptor positivity and lower tumor grade. However, no significant relationship was found between AR expression and pCR in the overall cohort or within molecular subtypes. Although AR-positive patients exhibited longer OS in univariate analysis (p = 0.024), this association was not sustained in multivariate models.Conclusion Although AR expression correlates with favorable clinicopathologic features in BC patients undergoing NAC, it is not an independent predictor of pathological response or long-term survival outcomes. A key limitation is the analysis of the entire cohort together; given the contrasting biological roles of AR across different molecular subtypes, future studies should evaluate TNBC and Luminal tumors separately.