Risk of CNS relapse following pathological complete response to neoadjuvant chemotherapy in early breast cancer

作者：Luciana de Moura Leite, Guilherme Rossato de Almeida, Monique Celeste Tavares, Marcelle Goldner Cesca, Fernando Augusto Batista Campos, Fernanda Alves de Oliveira, Débora Maciel Santana Dornellas, Erick F. Saldanha, Paula Tavares Guimarães, Daniella Dias Sá de Arruda, Maria Fernanda Simões Devides de Held, Rafael Lima Viana, Francisca Giselle Rocha Moura, Simone Klug Loose, Sinara Figueiredo Silva, Rafaela Pirolli, Camilla Albina Zanco Fogassa, Bruna Raphaeli Silva Mattos, S. Sanches, Vladmir C. Cordeiro De Lima · 发表于：Breast Cancer Research and Treatment · 年份：2026 · DOI：10.1007/s10549-026-07915-7 · 研究领域：Brain Metastases and Treatment、Breast Cancer Treatment Studies、Cancer-related cognitive impairment studies

PURPOSE: Pathological complete response (pCR) after neoadjuvant chemotherapy (NAC) improves outcomes in breast cancer (BC); however it may not prevent brain metastases. We evaluated central nervous system (CNS) recurrence patterns in early-stage BC following NAC according to pCR. METHODS: All consecutive stage I-III BC treated with NAC and surgery at a single center between 2007 and 2018 were analyzed. Endpoints included the impact of pCR on CNS recurrence across BC subtypes-hormone receptor-positive(HR)/HER2-negative, HER2-positive and triple-negative (TNBC), CNS recurrence patterns and overall survival (OS) after CNS relapse. Statistical comparisons included Fisher's Exact test, Chi-square, Kaplan-Meier, and regression analyses. RESULTS: Among 1147 patients, 537 had HR-positive/HER2-negative, 301 HER2-positive, 309 TNBC, mostly stage III, treated with anthracycline + taxane NAC, and trastuzumab if HER2-positive. Three hundred sixty-five achieved pCR (59/537 HR-positive/HER2-negative, 158/301 HER2-positive, 148/309 TNBC). CNS recurrence occurred in 72 (6.2%) patients, with no difference between pCR and non-pCR (4.7 vs. 7.0%, p = 0.15). Across subtypes, there was no difference for HR-positive/HER2-negative (3.4 vs. 4%, p = 1.0), TNBC (5.4 vs. 9.3%, p = 0.2), however there was a reduction in HER2-positive (4.4 vs. 14.7%, p = 0.003) after pCR. Isolated CNS relapse was the predominant pattern of CNS metastasis (82.4%) in pCR, particularly in HER2-positive. Median OS after CNS re...