ArticleFrontiers in oncology2026
Survival benefit of neoadjuvant chemotherapy in HR+/HER2- early breast cancer stratified by luminal B status and clinical risk: a real-world cohort study in a Chinese population.
Article in Frontiers in oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: The role of neoadjuvant chemotherapy (NACT) in hormone receptor-positive/HER2-negative (HR+/HER2-) breast cancer remains controversial. This real-world study evaluated the impact of NACT on overall survival (OS) and disease-free survival (DFS), specifically focusing on differential benefits within Luminal B and high-risk Luminal B subgroups. Methods: We retrospectively analyzed 990 patients with HR+/HER2- invasive breast cancer treated between 2013 and 2022. Patients received either NACT (n=195) or upfront surgery (n=795). "High-risk Luminal B" was defined as Luminal B subtype combined with clinical T3, N2, or Ki-67 ≥30%. Multivariable Cox regression adjusted for confounders to assess prognostic factors. Interaction tests evaluated heterogeneity in treatment effects across subgroups. Results: Despite higher baseline risk in the NACT group (larger tumors, higher grade), NACT was independently associated with better OS (HR 0.60, 95% CI 0.37-0.99) and DFS (HR 0.61, 95% CI 0.42-0.90) in the overall population. This benefit was most pronounced in the Luminal B subgroup (OS HR 0.47, 95% CI 0.26-0.84). A significant interaction was observed between treatment and risk status for OS (P for interaction = 0.026). Specifically, high-risk Luminal B patients achieved significantly higher 5-year OS with NACT (91.5% vs. 80.9%), whereas non-high-risk patients derived no survival benefit (adjusted HR 1.30). DFS showed consistent numerical trends but lacked significant interaction. Conclusion: NACT provided a survival advantage in this real-world HR+/HER2- cohort, with benefits primarily concentrated in high-risk Luminal B patients characterized by aggressive biology and high tumor burden. These findings support a risk-adapted strategy prioritizing NACT for this high-risk population while suggesting caution for lower-risk subgroups.
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