Exploring the relationship between transferrin and progression-free survival in breast cancer patients after neoadjuvant therapy

Background Since the first global cancer burden assessment report was released in the 1980s, breast cancer has consistently been the most frequently diagnosed malignancy in women. To this day, it remains the leading cause of cancer incidence and cancer-related mortality among women. Pathological evaluation of early breast cancer following neoadjuvant therapy is critical for providing prognostic information and guiding postoperative treatment decisions based on tumor response, including pathological complete response (pCR) and non-pCR status. Transferrin plays a central role in systemic iron metabolism, and dysregulated iron metabolism is a common hallmark of cancer. Therefore, exploring the relationship between transferrin and progression-free survival after neoadjuvant therapy for breast cancer can effectively predict the prognosis, thereby conferring positive clinical significance for subsequent treatment strategies. This study aimed to explore the association between transferrin and progression-free survival in breast cancer patients after neoadjuvant therapy. Method Research design We conducted a retrospective study on breast cancer patients admitted to the Affiliated Hospital of Jiangnan University between 2021 and 2025, focusing on patients hospitalized in the Department of Breast Surgery who underwent surgical resection following neoadjuvant chemotherapy. After excluding patients who did not meet the inclusion criteria of this study, a total of 166 eligible cases were ultimately included. Multivariate Cox proportional hazards regression analysis was used to explore the association between preoperative transferrin and progression-free survival in breast cancer patients receiving neoadjuvant chemotherapy. Restricted cubic spline (RCS) curves were employed to evaluate the nonlinear relationship between transferrin levels and the hazard ratio of progression-free survival, and ROC curves were used to assess the ability of transferrin to distinguish between high and low prognosis of PFS. Result This study included 166 patients with breast cancer. Multivariate Firth penalized Cox proportional hazards model analysis showed that transferrin (TRF) levels were independently associated with progression-free survival. The time-dependent AUC curve showed modest and fluctuating discriminative ability of TRF across the follow-up period, with values consistently ranging between 0.54 and 0.62 after the first year. Restricted cubic spline (RCS) analysis revealed an approximately linear monotonic increasing relationship between TRF and PFS (non-linearity test χ² = 1.46, P = 0.228). Kaplan-Meier survival curves demonstrated a clear distinction in progression-free survival between patients with high and low TRF levels. Conclusion TRF was significantly associated with progression-free survival in patients with neoadjuvant breast cancer. However, due to the limitations of this study, we are only doing preliminary exploration for information, and do not make any causal inference. A larger cohort is needed to explore in the future.