Caspian Journal of Internal Medicine
Babol University of Medical Sciences
Wed, May 27, 2026
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Volume 17, Issue 2 (Spring 2026)
Caspian J Intern Med 2026, 17(2): 14-0 |
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Ethics code: IR.MUI.MED.REC.1400.829
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Azarnia M, Sharifi M, Rezaeian Z, Arabzadeh S, Haghjooy Javanmard S. A Comparative Study on Relapse-Free Survival and Metastasis-Free Survival between Patients with Breast Cancer receiving Adjuvant or Neoadjuvant therapy: A retrospective Study in Isfahan, Iran. Caspian J Intern Med 2026; 17 (2) :14-0
URL: http://caspjim.com/article-1-4759-en.html
URL: http://caspjim.com/article-1-4759-en.html
Mina Azarnia 
, Mehran Sharifi * , Zahra Rezaeian , Saeedeh Arabzadeh , Shaghayegh Haghjooy Javanmard
, Mehran Sharifi * , Zahra Rezaeian , Saeedeh Arabzadeh , Shaghayegh Haghjooy Javanmard
Department of Internal Medicine, School of Medicine, Cancer Prevention Research Center, Seyyed Al-Shohada Hospital, Isfahan University of Medical Sciences, Isfahan, Iran , Sharifi.mehran5056@gmail.com
Abstract: (61 Views)
Background: Breast cancer is the most common malignancy among women in Iran and worldwide. Although both neoadjuvant and adjuvant chemotherapies are widely used, their impact on relapse-free survival (RFS) and metastasis-free survival (MFS) in real-world settings remains unclear. This study aimed to compare RFS and MFS between neoadjuvant and adjuvant chemotherapy in breast cancer patients.
Methods: A retrospective cohort study was conducted on patients who had received adjuvant or neoadjuvant therapy at Seyed Al-Shohada Hospital between July 2016 and July 2020. The cut-off date was July 202. Kaplan-Meier analysis and Cox regression models were used to evaluate RFS and MFS. To address potential confounding by indication due to non-randomized treatment assignment, inverse probability of treatment weighting (IPTW) was applied using propensity scores based on age, tumor grade, and molecular subtype.
Results: Neoadjuvant therapy was significantly associated with increased relapse risk compared to adjuvant therapy in both multivariate (HR = 3.06, p = 0.030) and IPTW-weighted models (HR = 6.10, p = 0.002). No significant difference in MFS was observed between treatment groups. TNBC was identified as the strongest predictor of metastasis (HR = 6.45, p = 0.001). Subtype-specific analyses revealed better outcomes with adjuvant therapy in Luminal A and improved MFS/RFS with neoadjuvant therapy in TNBC.
Conclusion: Adjuvant therapy was associated with better local disease control (RFS), while MFS was primarily influenced by tumor subtype. These findings highlighted the importance of subtype-tailored therapeutic strategies and supported the use of causal methods such as IPTW in observational oncology research.
Methods: A retrospective cohort study was conducted on patients who had received adjuvant or neoadjuvant therapy at Seyed Al-Shohada Hospital between July 2016 and July 2020. The cut-off date was July 202. Kaplan-Meier analysis and Cox regression models were used to evaluate RFS and MFS. To address potential confounding by indication due to non-randomized treatment assignment, inverse probability of treatment weighting (IPTW) was applied using propensity scores based on age, tumor grade, and molecular subtype.
Results: Neoadjuvant therapy was significantly associated with increased relapse risk compared to adjuvant therapy in both multivariate (HR = 3.06, p = 0.030) and IPTW-weighted models (HR = 6.10, p = 0.002). No significant difference in MFS was observed between treatment groups. TNBC was identified as the strongest predictor of metastasis (HR = 6.45, p = 0.001). Subtype-specific analyses revealed better outcomes with adjuvant therapy in Luminal A and improved MFS/RFS with neoadjuvant therapy in TNBC.
Conclusion: Adjuvant therapy was associated with better local disease control (RFS), while MFS was primarily influenced by tumor subtype. These findings highlighted the importance of subtype-tailored therapeutic strategies and supported the use of causal methods such as IPTW in observational oncology research.
Keywords: Breast cancer, adjuvant treatment, neoadjuvant therapy, metastasis-free survival (MFS), relapse-free survival (RFS)
Policy Brief: Original Article |
Subject:
Oncology
Received: 2025/05/4 | Accepted: 2025/09/23 | Published: 2026/03/24
Received: 2025/05/4 | Accepted: 2025/09/23 | Published: 2026/03/24
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