Pathological complete response and long-term outcomes after neoadjuvant therapy for breast cancer: a multicenter retrospective cohort study with exploratory subtype analyses
- 1Department of Thyroid and Breast Surgery, Nan’an Hospital
- 2Department of Breast Surgery, Quanzhou First Hospital Affiliated to Fujian Medical University
Abstract
Background: To examine differences in pathological complete response (pCR) rates across immunohistochemistry (IHC)-defined breast cancer surrogate subtypes and the association of pCR with recurrence-free survival (RFS) and breast cancer-specific survival (BCSS).
Methods: This retrospective multicenter study included 3,803 patients from the Shanghai Jiao Tong University Breast Cancer Database who received neoadjuvant therapy followed by surgery. Total pCR was defined as ypT0/is ypN0. Multivariable logistic and Cox regression assessed factors associated with pCR and its association with survival, respectively. Exploratory global subtype-by-pCR interaction tests were restricted to the remaining four subtypes with estimable within-subtype pCR contrasts. Sensitivity analyses included exploratory covariate-balancing analyses based on propensity score matching and overlap weighting, calendar-year adjustment, and subtype-stratified Cox models.
Results: Overall, 908 patients achieved pCR (23.88%), with rates differing across IHC-defined surrogate subtypes (P < 0.001). During a median follow-up of 46 months, pCR was associated with favorable RFS (adjusted HR 0.37, 95% CI 0.24–0.57) and BCSS (adjusted HR 0.30, 95% CI 0.18–0.50; both P < 0.001). Exploratory global interaction tests among the remaining four subtypes with estimable within-subtype pCR contrasts showed no statistical evidence of heterogeneity for RFS (P for interaction = 0.665) or BCSS (P for interaction = 0.718); Luminal A-like disease could not be included in these tests because no RFS or BCSS events occurred among the five patients who achieved pCR. Exploratory propensity-score matching yielded 907 pairs; matched-pair robust HRs were 0.43 (95% CI 0.27–0.69) for RFS and 0.38 (95% CI 0.22–0.64) for BCSS. Associations were consistent across the other sensitivity analyses.
Conclusion: pCR frequency varied across IHC-defined surrogate subtypes, and pCR was associated with favorable survival in the overall cohort. The exploratory interaction analyses did not establish effect modification among the four included subtypes; Luminal A-like disease could not be assessed for interaction because of sparse events. Subtype-specific survival estimates remain exploratory and require confirmation in adequately powered studies.
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BibTeX
@article{fu2026pathological,
title = {{Pathological complete response and long-term outcomes after neoadjuvant therapy for breast cancer: a multicenter retrospective cohort study with exploratory subtype analyses}},
author = {Shaolong Fu and Kaiyang Xiao and Sibao Huang and Zhishan Chen and Debo Chen and Weibin Lian},
journal = {Frontiers in Oncology},
year = {2026},
month = oct,
doi = {10.3389/fonc.2026.1994688},
url = {https://www.frontiersin.org/articles/10.3389/fonc.2026.1994688/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Pathological complete response and long-term outcomes after neoadjuvant therapy for breast cancer: a multicenter retrospective cohort study with exploratory subtype analyses
AU - Shaolong Fu
AU - Kaiyang Xiao
AU - Sibao Huang
AU - Zhishan Chen
AU - Debo Chen
AU - Weibin Lian
PY - 2026
DA - 2026/10/23
JO - Frontiers in Oncology
DO - 10.3389/fonc.2026.1994688
UR - https://www.frontiersin.org/articles/10.3389/fonc.2026.1994688/full
AB - Background: To examine differences in pathological complete response (pCR) rates across immunohistochemistry (IHC)-defined breast cancer surrogate subtypes and the association of pCR with recurrence-free survival (RFS) and breast cancer-specific survival (BCSS). Methods: This retrospective multicenter study included 3,803 patients from the Shanghai Jiao Tong University Breast Cancer Database who received neoadjuvant therapy followed by surgery. Total pCR was defined as ypT0/is ypN0. Multivariable logistic and Cox regression assessed factors associated with pCR and its association with survival, respectively. Exploratory global subtype-by-pCR interaction tests were restricted to the remaining four subtypes with estimable within-subtype pCR contrasts. Sensitivity analyses included exploratory covariate-balancing analyses based on propensity score matching and overlap weighting, calendar-year adjustment, and subtype-stratified Cox models. Results: Overall, 908 patients achieved pCR (23.88%), with rates differing across IHC-defined surrogate subtypes (P < 0.001). During a median follow-up of 46 months, pCR was associated with favorable RFS (adjusted HR 0.37, 95% CI 0.24–0.57) and BCSS (adjusted HR 0.30, 95% CI 0.18–0.50; both P < 0.001). Exploratory global interaction tests among the remaining four subtypes with estimable within-subtype pCR contrasts showed no statistical evidence of heterogeneity for RFS (P for interaction = 0.665) or BCSS (P for interaction = 0.718); Luminal A-like disease could not be included in these tests because no RFS or BCSS events occurred among the five patients who achieved pCR. Exploratory propensity-score matching yielded 907 pairs; matched-pair robust HRs were 0.43 (95% CI 0.27–0.69) for RFS and 0.38 (95% CI 0.22–0.64) for BCSS. Associations were consistent across the other sensitivity analyses. Conclusion: pCR frequency varied across IHC-defined surrogate subtypes, and pCR was associated with favorable survival in the overall cohort. The exploratory interaction analyses did not establish effect modification among the four included subtypes; Luminal A-like disease could not be assessed for interaction because of sparse events. Subtype-specific survival estimates remain exploratory and require confirmation in adequately powered studies.
SN - 2234-943X
ER -