Abstract:
Background: Pathological complete response (pCR) is a surrogate for the efcacy of neoadjuvant chemotherapy
(NCT) in locally advanced breast cancer (LABC). We analyzed the predictive clinical factors for pathological responses
and survival outcomes in a cohort of Egyptian patients.
Methods: We evaluated the medical records of patients with breast cancer who received NCT in our academic insti‑
tute. Survival curves were estimated with the Kaplan-Meier method. Cox proportional models were used for multiple
regression analysis.
Results: Our cohort included 368 patients with a median age of 48 years (range 21–70). The median follow-up time
was 3 years. The clinical tumor stage (T3–4) represented 58%, with 80% having positive axillary nodes. The luminal
subgroup prevailed by 68%. The objective response rate (ORR) reached 78%, and 16% of patients achieved pCR. The
clinical node stage and optimal chemotherapy were associated with higher ORR (p = 0.035 and p = 0.001, respec‑
tively). Predictors of pCR were clinical T-stage (p = 0.026), high Ki-67 index > 20 (p = 0.05), and receiving optimal
chemotherapy (p = 0.014). The estimated 3-year disease free-survival (DFS) was 53%. Receptor status, achieving ORR,
and pCR were associated with better DFS with hazard ratios of 0.56, p = 0.008; 0.38, p = 0.04; and 0.28, p = 0.007,
respectively.
Conclusions: Luminal tumors still draw beneft from neoadjuvant chemotherapy in terms of clinical response and
breast conservative surgery. Treatment escalation to those who did not achieve pCR requires more investigation,
given a higher recurrence rate in real-world experience.
