Sanli Ahmet Necati, Turan Bilal, Tekcan Sanli Deniz Esin, Karaca Isa, Altundag M Kadri, Aydogan Fatih
Department of General Surgery, Abdulkadir Yuksel State Hospital, Gaziantep, Turkey.
Department of General Surgery, Faculty of Medicine, Suleyman Demirel University, Çünür, Doğu yerleşkesi, 32260, Isparta, Turkey.
Breast Cancer Res Treat. 2025 Aug 28. doi: 10.1007/s10549-025-07812-5.
This study aimed to evaluate the prognostic relevance of stratified pathological response -complete response (CR), partial response (PR), and no response (NR)- to neoadjuvant chemotherapy (NAC) in patients with hormone receptor-positive and HER2-positive (HR + /HER2 +) breast cancer.
A total of 8277 HR + /HER2 + breast cancer patients treated with NAC between 2010 and 2021 were retrospectively identified from the SEER database. Patients were categorized into CR, PR, and NR groups. Overall survival (OS) and disease-specific survival (DSS) were analyzed using Kaplan-Meier and Cox regression models.
CR, PR, and NR rates were 52.3%, 41.4%, and 6.2%, respectively. Five-year OS rates were 96.3% (CR), 91.1% (PR), and 79.3% (NR), while 10-year DSS rates were 94.0% (CR), 83.4% (PR), and 76.2% (NR) (p < 0.001). In multivariate analysis, PR and NR were associated with significantly increased mortality risk compared to CR (OS HR: 2.16 and 4.20; DSS HR: 2.95 and 5.46; all p < 0.001). Progesterone receptor (PrgR) negativity independently predicted worse OS and DSS, whereas ER status had no significant impact. Additional adverse prognostic factors included advanced age, nodal metastasis, rural residence, and mastectomy. Radiotherapy did not retain significance in multivariate models.
Pathological response to NAC is a strong independent prognostic marker in HR + /HER2 + breast cancer. Partial responders represent a clinically distinct group with intermediate outcomes, highlighting the need for response-adapted therapeutic strategies beyond conventional staging systems.
本研究旨在评估激素受体阳性且人表皮生长因子受体2阳性（HR + /HER2 +）乳腺癌患者新辅助化疗（NAC）分层病理反应——完全缓解（CR）、部分缓解（PR）和无反应（NR）——的预后相关性。
从监测、流行病学和最终结果（SEER）数据库中回顾性识别出2010年至2021年间接受NAC治疗的8277例HR + /HER2 +乳腺癌患者。患者被分为CR、PR和NR组。使用Kaplan-Meier和Cox回归模型分析总生存期（OS）和疾病特异性生存期（DSS）。
CR、PR和NR率分别为52.3%、41.4%和6.2%。5年OS率分别为96.3%（CR）、91.1%（PR）和79.3%（NR），而10年DSS率分别为94.0%（CR）、83.4%（PR）和76.2%（NR）（p < 0.001）。在多变量分析中，与CR相比，PR和NR与死亡风险显著增加相关（OS风险比：2.16和4.20；DSS风险比：2.95和5.46；所有p < 0.001）。孕激素受体（PrgR）阴性独立预测更差的OS和DSS，而雌激素受体（ER）状态没有显著影响。其他不良预后因素包括高龄、淋巴结转移、农村居住和乳房切除术。放疗在多变量模型中没有显著意义。
NAC的病理反应是HR + /HER2 +乳腺癌中一个强有力的独立预后标志物。部分缓解者代表了一个临床结局中等的不同群体，突出了除传统分期系统外采用适应反应的治疗策略的必要性。
