Background: Neoadjuvant chemotherapy (NACT) is effective in downstaging locally advanced breast cancer, improving surgical and oncological outcomes. However, luminal B breast cancer typically exhibits a poorer response to NACT, with only 10–15% of patients achieving a pathologic complete response (pCR). This study investigates whether BRCA pathogenic variants (BRCA PVs) influence pCR rates in luminal B breast cancer patients, aiming to identify potential predictors for personalized treatment strategies.Materials and Methods: This retrospective study included luminal B breast cancer patients who underwent NACT at the Fondazione Policlinico Universitario Agostino Gemelli IRCCS between January 2014 and June 2023. Patients were stratified according to BRCA status: BRCA PVs and BRCA wild-type (WT). Primary endpoint was to evaluate pCR rates, while secondary endpoints included locoregional disease-free survival (LR-DFS), distant disease-free survival (DDFS), and overall survival (OS).Results: In total, 495 patients were enrolled, of whom 442 (89.3%) carried BRCA WT and 53 (10.7%) BRCA PVs. The pCR rate was significantly higher in the BRCA PVs group (20.8% PVs vs. 10.9% WT;p= 0.044). Specifically, the breast pCR rate was 28.3% in BRCA PVs versus 15.4% in BRCA WT (p= 0.030). BRCA WT patients had better 5-year LR-DFS (91.1% WT vs. 79.5% PVs;p= 0.003), while no significant differences were observed in 5-year DDFS or OS.Conclusions: BRCA PVs are associated with a higher pCR rate in luminal B breast cancer patients receiving NACT, suggesting a potential predictive role in tailoring treatment strategies.
背景：新辅助化疗（NACT）能有效降低局部晚期乳腺癌的分期，改善手术及肿瘤学预后。然而，Luminal B型乳腺癌通常对NACT反应较差，仅10–15%的患者能达到病理完全缓解（pCR）。本研究旨在探讨BRCA致病性变异（BRCA PVs）是否影响Luminal B型乳腺癌患者的pCR率，以期为个体化治疗策略寻找潜在的预测因子。 材料与方法：这项回顾性研究纳入了2014年1月至2023年6月期间在Fondazione Policlinico Universitario Agostino Gemelli IRCCS接受NACT的Luminal B型乳腺癌患者。根据BRCA状态将患者分层：BRCA PVs组和BRCA野生型（WT）组。主要终点是评估pCR率，次要终点包括局部区域无病生存期（LR-DFS）、远处无病生存期（DDFS）和总生存期（OS）。 结果：共纳入495例患者，其中442例（89.3%）为BRCA WT，53例（10.7%）为BRCA PVs。BRCA PVs组的pCR率显著更高（20.8% PVs vs. 10.9% WT；p=0.044）。具体而言，BRCA PVs组的乳腺pCR率为28.3%，而BRCA WT组为15.4%（p=0.030）。BRCA WT患者的5年LR-DFS更优（91.1% WT vs. 79.5% PVs；p=0.003），而5年DDFS或OS未见显著差异。 结论：在接受NACT的Luminal B型乳腺癌患者中，BRCA PVs与更高的pCR率相关，提示其在制定个体化治疗策略中可能具有预测价值。
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