Pathologic Response and Survival After Neoadjuvant Chemotherapy Among Breast Cancer Subtypes: Clinicopathologic and Survival Analysis from Azerbaijan
Altay Aliyev1, Natavan Azizova1, Tarana Huseynli1, Arturan Ibrahimli2, Iqbal Babazade1, Farida Aghayarli11Department of Oncology, Liv Bona Dea Hospital Baku, Azerbaijan, 2Cleveland Clinic Integrated Surgical Institute, Cleveland, Ohio, USA
Objectives: Neoadjuvant chemotherapy (NACT) has become a cornerstone in the management of locally advanced breast cancer, offering tumor downstaging, increased rates of breast-conserving surgery, and in vivo assessment of treatment response. Pathologic complete response (pCR) serves as a key prognostic indicator, with significant variability observed across molecular subtypes. However, limited data exist on survival outcomes and clinicopathological differences among these subtypes following NACT. Methods: This retrospective study analyzed 151 patients with stage II-III breast cancer treated with NACT at a tertiary referral center between 2016 and 2023. Patients were stratified by St. Gallen subtypes: luminal A (5%), luminal B HER2- negative (40%), luminal B HER2-positive (17%), HER2-positive (17%), and triple-negative (21%). The primary endpoint was pCR predictors, while secondary outcomes included overall survival (OS) analysis. Results: Results demonstrated significant subtype-dependent differences in pCR rates (p=0.001), with luminal B HER2- positive (42%) and HER2-positive (39%) achieving the highest responses, whereas luminal A (0%) and luminal B HER2- negative (12%) showed minimal response. Multivariate analysis identified younger age (<65 years), absence of lymphovascular invasion, and HER2-enriched subtypes as independent predictors of pCR (p<0.001). Survival analysis revealed subtype-dependent OS disparities (p<0.001), with triple-negative tumors exhibiting the worst prognosis (HR 18.2 vs. luminal B HER2-negative), while luminal B HER2-negative demonstrated the most favorable outcomes. Conclusion: These findings underscore the critical influence of molecular subtypes on treatment response and survival, reinforcing the need for subtype-specific NACT optimization. Despite limitations including retrospective design and sample size constraints, this study contributes valuable real-world data to guide therapeutic decision-making in breast cancer management Keywords: Breast cancer subtypes, pathologic complete response, overall survival
Cite This Article
Aliyev A, Azizova N, Huseynli T, Ibrahimli A, Babazade I, Aghayarli F. Pathologic Response and Survival After Neoadjuvant Chemotherapy Among Breast Cancer Subtypes: Clinicopathologic and Survival Analysis from Azerbaijan. EJMI. 2025; 9(3): 161-171
Corresponding Author: Altay Aliyev