Clinicopathologic Response to Neoadjuvant Chemotherapy in Breast Cancer Patients: A Retrospective Analysis from a Tertiary Care Hospital in Pakistan

Abstract

Background: Neoadjuvant chemotherapy (NACT) is an established treatment approach in breast cancer, particularly for locally advanced, triple-negative, and HER2-positive disease. It may reduce tumor burden, improve operability, facilitate breast-conserving surgery, and provide an in vivo assessment of tumor chemosensitivity. Evaluation of clinicopathologic factors associated with response is important for patient selection, surgical planning, and outcome prediction. Objective/Aim: To evaluate clinical and pathological responses to NACT and determine their association with molecular subtype and surgical outcomes among breast cancer patients treated at Recep Tayyip Erdogan Hospital, Muzaffargarh, Pakistan. Methods: This retrospective study was conducted using hospital electronic medical records from January 2022 to December 2024. Patients with breast cancer who received NACT and had documented post-treatment response assessment were included. Patients with metastatic breast cancer receiving palliative chemotherapy and those with incomplete records were excluded. Data regarding demographic characteristics, baseline TNM stage, imaging findings, histopathology, receptor status, molecular subtype, NACT cycles, surgical procedure, axillary surgery, and pathological response were extracted. Surgical outcomes were analyzed where surgical records were available. Data were analyzed using SPSS version 25. Results: A total of 252 records were reviewed, of which 31 were excluded due to incomplete data. The final analysis included 221 patients. Complete clinical/pathological response was recorded in 58 patients (26.2%), partial response in 82 (37.1%), no response in 73 (33.0%), and progressive disease in 8 (3.6%). Overall, 140 patients (63.3%) achieved favorable response. Total mastectomy was performed in 121 patients (54.8%), while wide local excision was performed in 96 (43.4%); surgical records were missing, not done, or not available in 4 patients (1.8%). Molecular subtype was significantly associated with complete response (p<0.001), with the highest complete response rate observed in HER2-enriched tumors. Conclusion: NACT produced favorable response in a substantial proportion of patients. Response differed significantly by molecular subtype, supporting subtype-informed patient selection and standardized response reporting in real-world breast cancer care