Pathologic complete response and breast cancer survival post-neoadjuvant chemotherapy: A systematic review and meta-analysis of real-world data
Breast cancer is a leading cause of cancer-related mortality worldwide, and neoadjuvant chemotherapy (NAC) plays a pivotal role in its management by reducing tumor size, enabling breast-conserving surgery, and improving survival outcomes. Achieving pathologic complete response (pCR) is strongly asso...
Saved in:
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-05-01
|
| Series: | Heliyon |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2405844025014501 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850123487881986048 |
|---|---|
| author | Marcelo Antonini André Mattar Thais Melo Pereira Ludmila Lemos Oliveira Marina Diógenes Teixeira Andressa Gonçalves Amorim Odair Ferraro Larissa Chrispim de Oliveira Marcellus do Nascimento Moreira Ramos Francisco Pimentel Cavalcante Felipe Zerwes Marcelo Madeira Leonardo Ribeiro Soares Eduardo Camargo Millen Antonio Luiz Frasson Fabricio Palermo Brenelli Gil Facina Rogerio Fenile Renata Arakelian Ruffo de Freitas Júnior Marcela Bonalumi dos Santos Henrique Lima Couto Luiz Henrique Gebrim |
| author_facet | Marcelo Antonini André Mattar Thais Melo Pereira Ludmila Lemos Oliveira Marina Diógenes Teixeira Andressa Gonçalves Amorim Odair Ferraro Larissa Chrispim de Oliveira Marcellus do Nascimento Moreira Ramos Francisco Pimentel Cavalcante Felipe Zerwes Marcelo Madeira Leonardo Ribeiro Soares Eduardo Camargo Millen Antonio Luiz Frasson Fabricio Palermo Brenelli Gil Facina Rogerio Fenile Renata Arakelian Ruffo de Freitas Júnior Marcela Bonalumi dos Santos Henrique Lima Couto Luiz Henrique Gebrim |
| author_sort | Marcelo Antonini |
| collection | DOAJ |
| description | Breast cancer is a leading cause of cancer-related mortality worldwide, and neoadjuvant chemotherapy (NAC) plays a pivotal role in its management by reducing tumor size, enabling breast-conserving surgery, and improving survival outcomes. Achieving pathologic complete response (pCR) is strongly associated with better overall survival (OS) and disease-free survival (DFS), particularly in aggressive subtypes such as triple-negative (TNBC) and HER2-positive breast cancers. This systematic review and meta-analysis evaluated the correlation between pCR, OS, and DFS in breast cancer patients treated with NAC, focusing exclusively on real-world data (RWD). A comprehensive search with PRISMA guidelines of major databases from 1999 to 2024 identified 22 retrospective studies comprising 12,115 patients. Hazard ratios (HRs) and confidence intervals (CIs) were pooled using random-effects models, and heterogeneity was assessed using the I2 statistic. pCR was achieved in 20.9 % of patients, with higher rates in HER2-positive (44.4 %) and TNBC (31.3 %) subtypes. Achieving pCR was associated with a 30 % improvement in OS (HR: 1.30; 95 % CI: 1.28–1.33) and a 29 % improvement in DFS (HR: 1.29; 95 % CI: 1.24–1.32). Among TNBC patients, pCR correlated with a 51 % increase in DFS (HR: 1.51; 95 % CI: 1.19–1.93). Significant heterogeneity (I2 = 96 %) was observed across studies. These findings highlight the importance of pCR as a robust predictor of improved survival outcomes in breast cancer, particularly in TNBC and HER2-positive subtypes, and underscore the need for strategies to increase pCR rates to enhance long-term survival and disease control. |
| format | Article |
| id | doaj-art-da646aacd6c641a1b6477d3bafc81ca0 |
| institution | OA Journals |
| issn | 2405-8440 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Heliyon |
| spelling | doaj-art-da646aacd6c641a1b6477d3bafc81ca02025-08-20T02:34:35ZengElsevierHeliyon2405-84402025-05-011110e4306910.1016/j.heliyon.2025.e43069Pathologic complete response and breast cancer survival post-neoadjuvant chemotherapy: A systematic review and meta-analysis of real-world dataMarcelo Antonini0André Mattar1Thais Melo Pereira2Ludmila Lemos Oliveira3Marina Diógenes Teixeira4Andressa Gonçalves Amorim5Odair Ferraro6Larissa Chrispim de Oliveira7Marcellus do Nascimento Moreira Ramos8Francisco Pimentel Cavalcante9Felipe Zerwes10Marcelo Madeira11Leonardo Ribeiro Soares12Eduardo Camargo Millen13Antonio Luiz Frasson14Fabricio Palermo Brenelli15Gil Facina16Rogerio Fenile17Renata Arakelian18Ruffo de Freitas Júnior19Marcela Bonalumi dos Santos20Henrique Lima Couto21Luiz Henrique Gebrim22Hospital do Servidor Público Estadual Francisco Morato de Oliveira, São Paulo, SP, Brazil; Centro de Desenvolvimento de Ensino e Pesquisa do Instituo de Assistência Médica ao Servidor Público Estadual (CEDEP – IAMSPE), São Paulo, SP, Brazil; BBREAST - Brazilian Breast Association Team, São Paulo, SP, Brazil; Corresponding author. Rua Cayowaa 1575, Ap. 72, 01258-011, São Paulo, SP, Brazil.Women's Health Hospital, São Paulo, SP, Brazil; BBREAST - Brazilian Breast Association Team, São Paulo, SP, BrazilHospital do Servidor Público Estadual Francisco Morato de Oliveira, São Paulo, SP, BrazilHospital do Servidor Público Estadual Francisco Morato de Oliveira, São Paulo, SP, BrazilWomen's Health Hospital, São Paulo, SP, BrazilWomen's Health Hospital, São Paulo, SP, BrazilHospital do Servidor Público Estadual Francisco Morato de Oliveira, São Paulo, SP, BrazilWomen's Health Hospital, São Paulo, SP, BrazilWomen's Health Hospital, São Paulo, SP, BrazilHospital Geral de Fortaleza, Fortaleza, CE, Brazil; BBREAST - Brazilian Breast Association Team, São Paulo, SP, BrazilPontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil; BBREAST - Brazilian Breast Association Team, São Paulo, SP, BrazilFaculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, SP, BrazilUniversidade Federal de Goias, Goiania, GO, BrazilRede D’Or, Rio de Janeiro, RJ, Brazil; BBREAST - Brazilian Breast Association Team, São Paulo, SP, BrazilHospital Albert Einstein, São Paulo, SP, Brazil; BBREAST - Brazilian Breast Association Team, São Paulo, SP, BrazilUniversidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil; BBREAST - Brazilian Breast Association Team, São Paulo, SP, BrazilUniversidade Federal de São Paulo, São Paulo, São Paulo, BrazilHospital Ipiranga, São Paulo, São Paulo, BrazilWomen's Health Hospital, São Paulo, SP, Brazil; DASA Oncologia, São Paulo, BrazilCORA Advanced Center for Breast Cancer Diagnosis, Federal University of Goias, BrazilWomen's Health Hospital, São Paulo, SP, BrazilRedimama - Redimasto, Belo Horizonte, MG, BrazilHospital Beneficência Portuguesa, São Paulo, São Paulo, BrazilBreast cancer is a leading cause of cancer-related mortality worldwide, and neoadjuvant chemotherapy (NAC) plays a pivotal role in its management by reducing tumor size, enabling breast-conserving surgery, and improving survival outcomes. Achieving pathologic complete response (pCR) is strongly associated with better overall survival (OS) and disease-free survival (DFS), particularly in aggressive subtypes such as triple-negative (TNBC) and HER2-positive breast cancers. This systematic review and meta-analysis evaluated the correlation between pCR, OS, and DFS in breast cancer patients treated with NAC, focusing exclusively on real-world data (RWD). A comprehensive search with PRISMA guidelines of major databases from 1999 to 2024 identified 22 retrospective studies comprising 12,115 patients. Hazard ratios (HRs) and confidence intervals (CIs) were pooled using random-effects models, and heterogeneity was assessed using the I2 statistic. pCR was achieved in 20.9 % of patients, with higher rates in HER2-positive (44.4 %) and TNBC (31.3 %) subtypes. Achieving pCR was associated with a 30 % improvement in OS (HR: 1.30; 95 % CI: 1.28–1.33) and a 29 % improvement in DFS (HR: 1.29; 95 % CI: 1.24–1.32). Among TNBC patients, pCR correlated with a 51 % increase in DFS (HR: 1.51; 95 % CI: 1.19–1.93). Significant heterogeneity (I2 = 96 %) was observed across studies. These findings highlight the importance of pCR as a robust predictor of improved survival outcomes in breast cancer, particularly in TNBC and HER2-positive subtypes, and underscore the need for strategies to increase pCR rates to enhance long-term survival and disease control.http://www.sciencedirect.com/science/article/pii/S2405844025014501Neoadjuvant chemotherapyPathologic complete responseBreast cancerSurvivalDisease-free survivalHER2-Positive |
| spellingShingle | Marcelo Antonini André Mattar Thais Melo Pereira Ludmila Lemos Oliveira Marina Diógenes Teixeira Andressa Gonçalves Amorim Odair Ferraro Larissa Chrispim de Oliveira Marcellus do Nascimento Moreira Ramos Francisco Pimentel Cavalcante Felipe Zerwes Marcelo Madeira Leonardo Ribeiro Soares Eduardo Camargo Millen Antonio Luiz Frasson Fabricio Palermo Brenelli Gil Facina Rogerio Fenile Renata Arakelian Ruffo de Freitas Júnior Marcela Bonalumi dos Santos Henrique Lima Couto Luiz Henrique Gebrim Pathologic complete response and breast cancer survival post-neoadjuvant chemotherapy: A systematic review and meta-analysis of real-world data Heliyon Neoadjuvant chemotherapy Pathologic complete response Breast cancer Survival Disease-free survival HER2-Positive |
| title | Pathologic complete response and breast cancer survival post-neoadjuvant chemotherapy: A systematic review and meta-analysis of real-world data |
| title_full | Pathologic complete response and breast cancer survival post-neoadjuvant chemotherapy: A systematic review and meta-analysis of real-world data |
| title_fullStr | Pathologic complete response and breast cancer survival post-neoadjuvant chemotherapy: A systematic review and meta-analysis of real-world data |
| title_full_unstemmed | Pathologic complete response and breast cancer survival post-neoadjuvant chemotherapy: A systematic review and meta-analysis of real-world data |
| title_short | Pathologic complete response and breast cancer survival post-neoadjuvant chemotherapy: A systematic review and meta-analysis of real-world data |
| title_sort | pathologic complete response and breast cancer survival post neoadjuvant chemotherapy a systematic review and meta analysis of real world data |
| topic | Neoadjuvant chemotherapy Pathologic complete response Breast cancer Survival Disease-free survival HER2-Positive |
| url | http://www.sciencedirect.com/science/article/pii/S2405844025014501 |
| work_keys_str_mv | AT marceloantonini pathologiccompleteresponseandbreastcancersurvivalpostneoadjuvantchemotherapyasystematicreviewandmetaanalysisofrealworlddata AT andremattar pathologiccompleteresponseandbreastcancersurvivalpostneoadjuvantchemotherapyasystematicreviewandmetaanalysisofrealworlddata AT thaismelopereira pathologiccompleteresponseandbreastcancersurvivalpostneoadjuvantchemotherapyasystematicreviewandmetaanalysisofrealworlddata AT ludmilalemosoliveira pathologiccompleteresponseandbreastcancersurvivalpostneoadjuvantchemotherapyasystematicreviewandmetaanalysisofrealworlddata AT marinadiogenesteixeira pathologiccompleteresponseandbreastcancersurvivalpostneoadjuvantchemotherapyasystematicreviewandmetaanalysisofrealworlddata AT andressagoncalvesamorim pathologiccompleteresponseandbreastcancersurvivalpostneoadjuvantchemotherapyasystematicreviewandmetaanalysisofrealworlddata AT odairferraro pathologiccompleteresponseandbreastcancersurvivalpostneoadjuvantchemotherapyasystematicreviewandmetaanalysisofrealworlddata AT larissachrispimdeoliveira pathologiccompleteresponseandbreastcancersurvivalpostneoadjuvantchemotherapyasystematicreviewandmetaanalysisofrealworlddata AT marcellusdonascimentomoreiraramos pathologiccompleteresponseandbreastcancersurvivalpostneoadjuvantchemotherapyasystematicreviewandmetaanalysisofrealworlddata AT franciscopimentelcavalcante pathologiccompleteresponseandbreastcancersurvivalpostneoadjuvantchemotherapyasystematicreviewandmetaanalysisofrealworlddata AT felipezerwes pathologiccompleteresponseandbreastcancersurvivalpostneoadjuvantchemotherapyasystematicreviewandmetaanalysisofrealworlddata AT marcelomadeira pathologiccompleteresponseandbreastcancersurvivalpostneoadjuvantchemotherapyasystematicreviewandmetaanalysisofrealworlddata AT leonardoribeirosoares pathologiccompleteresponseandbreastcancersurvivalpostneoadjuvantchemotherapyasystematicreviewandmetaanalysisofrealworlddata AT eduardocamargomillen pathologiccompleteresponseandbreastcancersurvivalpostneoadjuvantchemotherapyasystematicreviewandmetaanalysisofrealworlddata AT antonioluizfrasson pathologiccompleteresponseandbreastcancersurvivalpostneoadjuvantchemotherapyasystematicreviewandmetaanalysisofrealworlddata AT fabriciopalermobrenelli pathologiccompleteresponseandbreastcancersurvivalpostneoadjuvantchemotherapyasystematicreviewandmetaanalysisofrealworlddata AT gilfacina pathologiccompleteresponseandbreastcancersurvivalpostneoadjuvantchemotherapyasystematicreviewandmetaanalysisofrealworlddata AT rogeriofenile pathologiccompleteresponseandbreastcancersurvivalpostneoadjuvantchemotherapyasystematicreviewandmetaanalysisofrealworlddata AT renataarakelian pathologiccompleteresponseandbreastcancersurvivalpostneoadjuvantchemotherapyasystematicreviewandmetaanalysisofrealworlddata AT ruffodefreitasjunior pathologiccompleteresponseandbreastcancersurvivalpostneoadjuvantchemotherapyasystematicreviewandmetaanalysisofrealworlddata AT marcelabonalumidossantos pathologiccompleteresponseandbreastcancersurvivalpostneoadjuvantchemotherapyasystematicreviewandmetaanalysisofrealworlddata AT henriquelimacouto pathologiccompleteresponseandbreastcancersurvivalpostneoadjuvantchemotherapyasystematicreviewandmetaanalysisofrealworlddata AT luizhenriquegebrim pathologiccompleteresponseandbreastcancersurvivalpostneoadjuvantchemotherapyasystematicreviewandmetaanalysisofrealworlddata |