The Five-years Overall Survival and Recurrence Free Survival of Neoadjuvant Systemic Therapy in Breast Cancer Sudanese Patients: A Retrospective Comparative study

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The role of neoadjuvant chemotherapy (NAC) in improving clinical outcomes for breast cancer patients has gained significant attention; however, its impact on long-term survival and recurrence rates remains under investigation. Thus, we evaluated the effectiveness of NAC on metastasis, recurrence rates, and overall survival in BC patients. Statistical analyses, including Chi-square tests and Kaplan-Meier survival analysis, were employed to assess differences between groups. Methods In this retrospective study, 46 Sudanese patients with locally advanced BC were consecutively collected attending Alsharif Specialized Hospital during the period from 2015 to 2016, comprising 28 patients who received NAC (case group) and 18 patients who underwent upfront surgery (control group). Data regarding demographics, histological types, treatment regimens, prognostic markers, survival, recurrence and metastasis were collected Results Most of patients in both groups were > 40 years old. Invasive ductal carcinoma (IDC) was the predominant histological type observed. Notably, the metastasis rate was lower in the case group than in the control group (n=6; 21.4% vs. n=9; 50%, P = 0.043). However, the recurrence rates and overall survival did not differ significantly between the two groups (P = 0.353 and P = 0.454, respectively). The estimated mean survival time was 74.1 months for the case group compared to 82.0 months for the control group, but without significant difference (log-rank P = 0.973). Conclusion While NAC appears to reduce metastasis rates in breast cancer patients, it does not significantly impact recurrence rates or overall survival. These results underscore the need for further research to explore additional factors that influence long-term outcomes of breast cancer management. 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F1000Research 2025, 14 :55 ( https://doi.org/10.12688/f1000research.159563.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Research Article The Five-years Overall Survival and Recurrence Free Survival of Neoadjuvant Systemic Therapy in Breast Cancer Sudanese Patients: A Retrospective Comparative study [version 1; peer review: 1 approved] Tamador Elhadi Osman https://orcid.org/0000-0002-5072-4328 1 , Ayda Hussein Omer Mustafa https://orcid.org/0000-0001-7310-9208 2 , Rayan Ali Abdalla 3 , Osman Amir https://orcid.org/0000-0003-0097-5636 4 , Hamid Ali Abd Alrahman 5 Tamador Elhadi Osman https://orcid.org/0000-0002-5072-4328 1 , Ayda Hussein Omer Mustafa https://orcid.org/0000-0001-7310-9208 2 , [...] Rayan Ali Abdalla 3 , Osman Amir https://orcid.org/0000-0003-0097-5636 4 , Hamid Ali Abd Alrahman 5 PUBLISHED 09 Jan 2025 Author details Author details 1 General Surgery, Khartoum Teaching Hospital, Khartoum, Khartoum, 0000, Sudan 2 Faculty of Medicine, Al Neelain University, Khartoum, Khartoum, 0000, Sudan 3 General Surgery, Ibn Sina Specialized Hospital, Khartoum, Khartoum, 0000, Sudan 4 Hematology, Karary University, Omdurman, Khartoum, 0000, Sudan 5 Faculty of Medicine, University of Gezira, Wad Madani, Al Jazirah, 0000, Sudan Tamador Elhadi Osman Roles: Conceptualization, Funding Acquisition, Investigation, Methodology, Project Administration, Resources, Software, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Ayda Hussein Omer Mustafa Roles: Conceptualization, Investigation, Methodology, Project Administration, Resources, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Rayan Ali Abdalla Roles: Investigation, Methodology, Resources, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Osman Amir Roles: Data Curation, Formal Analysis, Methodology, Software, Writing – Original Draft Preparation, Writing – Review & Editing Hamid Ali Abd Alrahman Roles: Investigation, Methodology, Software, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS Abstract Background Breast cancer (BC) is a leading cause of cancer-related mortality among women worldwide. The role of neoadjuvant chemotherapy (NAC) in improving clinical outcomes for breast cancer patients has gained significant attention; however, its impact on long-term survival and recurrence rates remains under investigation. Thus, we evaluated the effectiveness of NAC on metastasis, recurrence rates, and overall survival in BC patients. Statistical analyses, including Chi-square tests and Kaplan-Meier survival analysis, were employed to assess differences between groups. Methods In this retrospective study, 46 Sudanese patients with locally advanced BC were consecutively collected attending Alsharif Specialized Hospital during the period from 2015 to 2016, comprising 28 patients who received NAC (case group) and 18 patients who underwent upfront surgery (control group). Data regarding demographics, histological types, treatment regimens, prognostic markers, survival, recurrence and metastasis were collected Results Most of patients in both groups were > 40 years old. Invasive ductal carcinoma (IDC) was the predominant histological type observed. Notably, the metastasis rate was lower in the case group than in the control group (n=6; 21.4% vs. n=9; 50%, P = 0.043). However, the recurrence rates and overall survival did not differ significantly between the two groups (P = 0.353 and P = 0.454, respectively). The estimated mean survival time was 74.1 months for the case group compared to 82.0 months for the control group, but without significant difference (log-rank P = 0.973). Conclusion While NAC appears to reduce metastasis rates in breast cancer patients, it does not significantly impact recurrence rates or overall survival. These results underscore the need for further research to explore additional factors that influence long-term outcomes of breast cancer management. READ ALL READ LESS Keywords Breast cancer, metastasis, neoadjuvant chemotherapy, overall survival, recurrence, Sudanese Corresponding Author(s) Tamador Elhadi Osman ( [email protected] ) Osman Amir ( [email protected] ) Close Corresponding authors: Tamador Elhadi Osman, Osman Amir Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2025 Osman TE et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Osman TE, Mustafa AHO, Abdalla RA et al. The Five-years Overall Survival and Recurrence Free Survival of Neoadjuvant Systemic Therapy in Breast Cancer Sudanese Patients: A Retrospective Comparative study [version 1; peer review: 1 approved] . F1000Research 2025, 14 :55 ( https://doi.org/10.12688/f1000research.159563.1 ) First published: 09 Jan 2025, 14 :55 ( https://doi.org/10.12688/f1000research.159563.1 ) Latest published: 09 Jan 2025, 14 :55 ( https://doi.org/10.12688/f1000research.159563.1 ) Introduction Breast cancer (BC) remains one of the most prevalent malignancies affecting women globally, with almost 80% of mortalities recoded in low- and middle-income countries (LMICs). Its prevalence rates in Sub-Saharan Africa are on the increase, determined by lifestyle conversions, urbanization, and reduced birth rates. 1 Breast cancer incidence in Africa has been on the rise, with nearly 169,000 cases reported in 2018. Projections by GLOBOCAN indicate that this number could nearly double by 2040 if current trends continue. This escalating burden highlights a critical public health challenge across the continent. 2 In Sudan, there is no national population-BC registry, leading to cancer estimates primarily relying on hospital case series. Data from the Cancer Registry for Khartoum State during 2009-2010 indicated that BC was the most prevalent cancer among Sudanese women. 3 According to statistics from the National Cancer Institute—University of Gezira (NCI–UG), BC accounted for 34% of all cancers in female cases in 2017. 4 Research on the clinicopathologic features of BC in Sudan has shown that Sudanese women are diagnosed at a younger age and at more advanced stages, with higher tumor grades and greater lymph node involvement compared to women in developed countries. This trend mirrors findings from other sub-Saharan African nations, highlighting the urgent need for improved awareness and early detection strategies in Sudan. 5 , 6 Although locally advanced breast cancer (LABC) is relatively rare among women in the Western world, it is a common occurrence in Sudan, where it tends to affect women at a younger age. 7 And the high LABC prevalence in Sudan attributed to such factors like seeking traditional healing, fear of stigma, and fear of treatments side effects as reported by one recent study. 8 Breast cancer remains a significant health challenge, particularly in its LABC, which are characterized by larger tumor sizes and regional lymph node involvement. Traditionally, the treatment approach for LABC has included surgery followed by adjuvant chemotherapy. However, the introduction of neoadjuvant chemotherapy (NAC) has shifted this paradigm. NAC is administered prior to surgery with the dual objectives of reducing tumor size to facilitate breast-conserving surgery and providing early systemic treatment to address potential micrometastatic disease. 9 , 10 NAC has gained traction due to its potential to improve surgical outcomes and provide prognostic information based on the pathological response. Achieving a pathologic complete response (pCR) after NAC is associated with improved disease-free survival (DFS) and overall survival (OS) rates. 10 , 11 Studies indicate that patients who achieve pCR exhibit significantly better outcomes compared to those who do not, with 5-year DFS rates reported at 73.17% for pCR patients versus 51.25% for those with residual disease. 10 Despite these advantages, the comparative effectiveness of NAC versus surgery-first strategies remains a topic of investigation. Some studies have shown no statistically significant differences in overall survival between neoadjuvant and adjuvant chemotherapy groups, suggesting that while NAC may enhance surgical options and reduce tumor burden, it does not necessarily confer a survival advantage over traditional adjuvant approaches. 9 , 12 For illustration, a meta-analysis involving over 4,700 patients revealed that while NAC improved local therapy feasibility and response rates, long-term outcomes such as distant recurrence and breast cancer mortality were comparable to those seen with adjuvant chemotherapy. 12 Furthermore, the decision-making process regarding treatment strategies for LABC must consider various factors including tumor biology, patient preferences, and the potential for breast-conserving surgery. While NAC can lead to downstaging of tumors and increased rates of breast-conserving surgery, it is crucial to weigh these benefits against the overall survival outcomes observed in clinical practice. 9 In summary, while NAC offers several advantages in managing locally advanced breast cancer, including improved surgical options and potential prognostic insights, its impact on overall survival compared to surgery-first approaches is debatable requires further investigation through further studies, as no study in Sudan examined this. The ongoing evaluation of long-term outcomes will be essential in refining treatment protocols for this challenging patient population. As, no study in Sudan examined this topic we aim in this work to find out the 5-years overall survival and recurrence free survival of NAC in Sudanese women with LABC. Methods Study design This is a retrospective comparative hospital-based study consecutively enrolled 46 BC patients by. Among them, 28 received neoadjuvant as case group and 18 had not as control group during the period from 2015 to 2016 and follow them for 5 years. This study included in Alsharif Specialized Hospital, Khartoum State, Sudan. It’s a centrally located clinic with significantly high load of breast cancer patients, treating almost 700 cases of breast disease per year, presenting from all over the states of the country. This clinic has very precise data registry and follow up strategies. Inclusion criteria All female patients with LABC, non-inflammatory, who filled the criteria for primary systemic therapy (which is patients with locally advanced breast cancer or patients with large tumor which needs downsizing to fit breast conservative surgery) and underwent post systemic therapy mastectomy or breast conservative surgery in the clinic, included in this study. The invasive breast cancer was confirmed by histopathology examination of true-cut biopsy from the lesion, and immunohistochemistry should be done for receptor status (ER, PR, HER-2 and Ki67). Before starting the primary systemic therapy, the patient performed the staging evaluation, which includes in addition to the proper history and examination, CT thorax, abdomen and pelvis and bone scan. Excluding patients who didn’t get surgery after the Neo-adjuvant therapy and patients who lost their follow up. Exclusion criteria Patient with early breast cancer (stage I/II), those who don’t have histology examination, receptor status and staging data prior to the therapy and those who haven’t had regular follow-up during the study were excluded from study. Data collection tools and methods Data was collected from the breast clinic patient’s record using a structured questionnaire (DOI: 10.6084/m9.figshare.27905544 ) list composed of patient’s demographics, symptoms duration, histological types, treatment regimens, types of the surgeries and prognostic markers such as ER, PR, HER2 status, and Ki67 levels. Various chemotherapy regimens have been employed according to standard practices over the years. For a significant duration, the standard neoadjuvant treatment protocol consisted of 5-fluorouracil, epirubicin, and cyclophosphamide (FEC). Two specific dosing schedules were utilized: one involved administering 500 mg/m 2 of 5-fluorouracil, 75 mg/m 2 of epirubicin, and 500 mg/m 2 of cyclophosphamide, while the other used 600 mg/m 2 of 5-fluorouracil, 60 mg/m 2 of epirubicin, and 600 mg/m 2 of cyclophosphamide. Both regimens were administered for 3-4 cycles, with each cycle lasting 21 days. Other medications can be used as a single agent for example: gemzar for the elder or TEC for the Young. Statistical analysis Data analyzed by using SPSS statistics (IBM Corp. (2019) IBM SPSS Statistics for Windows, Version 22.0. IBM Corp., Armonk, NY.). The statistical analyses performed in this article using SPSS21 software can be conducted using the freely accessible software Jamovi https://www.jamovi.org ( DOI: 10.24384/ hgc3-7p15 ). The user manual is available at the following link. https://lsj.readthedocs.io/ru/latest/Ch03/Ch03_jamoviIntro_1.html . Statistical analyses were conducted using Chi-square tests to evaluate the significance of differences between groups regarding various clinical outcomes. A significance level of P < 0.05 (2-sided) was established for all tests. Kaplan-Meier survival analysis was employed to estimate survival times for both groups, allowing for a comprehensive comparison of overall survival rates. The log-rank test was utilized to assess the statistical significance of differences in survival curves. Ethical consideration Ethical approval was obtained from the General Surgery Institutional Review Board (IRB) at the Sudan Medical Specialization Board (SMSB) (02/2020), and performed following the ethical standards of the 1964 Declaration of Helsinki. 13 To ensure participant confidentiality, data were collected anonymously using identity numbers instead of names. This information is securely stored in a separate file, and no individual participant is referenced in the study reports. Only the study staff have access to the identities of the participants. Results In total, this study included 28 LABC females receiving NAC as the case group compared to 18 upfront surgery patients as the control group. Most of the patients in the case (n = 16; 57.1%) and control group (n = 14; 77.8%) were aged above 40 years (P value = 0.150). The majority of the patients in the case group (n = 12; 42.9%) had symptoms lasting from 3-6 months and in the control group (n = 10; 55.6%) from 7-12 months (P value = 0.199). Invasive ductal carcinoma (IDC) was the most common histological type in the case group (78.5%) and control group (50%) documented cases and mainly were grade 3 in both groups (case = 35.7%, control = 22.2%). Most of the patients in the case group (n = 14; 50%) and control group (n = 8; 44.4%) underwent modified radical mastectomy (MRM) plus axillary lymph node clearance (ALC) surgeries. Other patients’ details are revealed in Table 1 . Table 1. The baseline characteristics of the study groups. Case; n(%) (N=28) Control; n(%) (N=18) P value Age (Years) • ≤40 12(42.9) 4(22.2) 0.150 a • >40 16(57.1) 14(77.8) Symptoms duration (months) • 12 3(10.7) 0(0) Histological types and grades • IDC grade-I 6(21.4) 3(16.7) 0.213 a • IDC grade-II 6(21.4) 2(11.1) • IDC grade-III 10(35.7) 4(22.2) • ILC 1(3.6) 0(0) • Not documented 5(17.9) 9(50) Surgery types • MRM 7(25) 4(22.2) 0.829 a • MRM & ALC 14(50) 8(44.4) • WLE & ALC 7(25) 6(33.3) Follow-up duration (Years) • 3-5 22(78.6) 18(100) 0.040 a * • >5 6(21.4) 0(0) a Chi-square test was used. * P value is significant (< 0.05). As shown in Figure 1 , most of the patients in NAC group 13 (46.4%) received six cycles of chemotherapy. Figure 1. XXX. Table 2 revealed the prognostic markers, in which ER/PR were +ve/+ve or +ve/-ve in four (14.3%) of the case group and four (22.2%) patients in the control group (P value = 0.469). The HER2 was positive in six (21.4%) of the case group and one (5.6%) patient in the control group (P value = 0.334). The Ki67 below 20% was found in four (14.3%) of the case group and three (16.7%) patients of control groups (P = 0.969). Table 2 revealed the prognostic markers, in which ER/PR were +ve/+ve or +ve/-ve in four (14.3%) of the case group and four (22.2%) patients in the control group (P value = 0.469). The HER2 was positive in six (21.4%) of the case group and one (5.6%) patient in the control group (P value = 0.334). The Ki67 below 20% was found in four (14.3%) of the case group and three (16.7%) patients of control groups (P = 0.969). Table 2. The results of prognostic markers (ER/PR, HER2, Ki67) in case and control groups. Case; n(%) (N=28) Control; n(%) (N=18) P value ER/PR • +ve/+ve or +ve/-ve 4(14.3) 4(22.2) 0.469 a • -ve/-ve 9(32.1) 3(16.7) • Not documented 15(53.6) 11(61.1) HER2 • +ve 6(21.4) 1(5.6) 0.334 a • -ve 7(25) 6(33.3) • Not documented 15(53.6) 11(61.1) Ki67 • 20% 7(25) 0(0) • Not documented 17(60.7) 15(83.3) a Chi-square test was used. Table 3 illustrates that the rate of metastasis was significantly greater in the controls compared to the case group (n = 9; 50% vs n = 6; 21.4%; P value = 0.043), while the recurrence rate was not significantly differed between the groups (P value = 0.353). Table 3. The rates of metastasis and recurrence among in case and control groups. Case; n(%) (N=28) Control; n(%) (N=18) P. value Metastasis 6(21.4) 9(50) 0.043 a * Recurrence 4(14.3) 1(5.6) 0.353 a a Chi-square test was used. * P value is significant (< 0.05). Moreover, as revealed in Table 4 , the development of metastasis and recurrence was not significantly affected by the types of surgery in the case (P value = 0.655) and control groups (P value = 0.529). Table 4. The distribution of metastasis and recurrence according to surgery types in case and control groups. Case group Control group Metastasis; n(%) Recurrence; n(%) None; n(%) P Metastasis; n(%) Recurrence; n(%) None; n(%) P value MRM 2(28.6) 0(0) 5(71.4) 0.655 a 3(75) 0(0) 1(25) 0.529 a MRM+ALC 3(21.4) 2(14.3) 9(64.3) 5(50) 1(12.5) 3(37.5) WLE+ALC 1(14.3) 2(28.6) 4(57.1) 2(33.3) 0(0) 4(66.7) a Chi-square test was used. Table 5 demonstrated that the 5-year overall survival rate was 50% (n = 14) in the case group and 55.6% (n = 10) in the control group, but it was not statistically significant (P value = 0.454). Table 5. The 5-years survival in case and control groups. Case; n(%) (N=28) Control; n(%) (N=18) P value 5-years overall survival (OS) • Alive 14(50) 8(44.4) 0.454 a • Dead 14(50) 10(55.6) a Chi-square test was used. Kaplan-Meier survival analysis illustrated that the estimated mean of survival time was 74.1 (95% CI: 71.5 – 92.5) months in the case group and 82.0 (95% CI: 64.2 – 84.1) months in the control group. Nonetheless, the difference was not statistically significant (log-rank sign value = 0.973), as illustrated in Table 6 and Figure 2 . Table 6. The survival time analysis in case and control groups. Survival Time Analysis (months) Log Rank Sign Estimated Mean 95%CI Lower Bound 95%CI Upper Bound Case 74.1 64.2 84.1 0.973 Control 82.0 71.5 92.5 Figure 2. XXX. As presented in Table 7 the association between 5-year overall survival was not significantly affected by the duration of symptoms (P value = 0.833), ER/PR expression (P value = 0.915), HER2 expression (P value = 0.364), and levels of Ki67 (P value = 0.548) in the case group. However, the 5-year mortality rate was higher in IDC grade-3 (n = 6; 42.9%) than in IDC grade-2 (n = 2; 14.3%), IDC grade-1 (n = 2; 14.3%) and ILC (n = 1; 7.1%) in the case group, but the differences was statistically insignificant (P value = 0.569). Table 7. The association between 5-years outcomes and selected variables in case group. Alive; n(%) (n=14) Dead; n(%) (n=14) P value Symptoms duration • 6-12 months 4(28.6) 4(25.6) • >12 months 2(14.3) 1(7.1) Histological type and grades • IDC G-1 4(28.6) 2(14.3) 0.569 a • IDC G-2 4(28.6) 2(14.3) • IDC G-3 4(28.6) 6(42.9) • ILC 0(0) 1(7.1) • Not documented 2(14.3) 3(21.4) ER/PR • +ve/+ve or +ve/-ve 2(14.3) 2(14.3) 0.915 a • -ve/-ve 4(28.6) 5(35.7) • Not documented 8(57.1) 7(50) HER2 • +ve 4(28.6) 2(14.3) 0.364 a • -ve 2(14.3) 5(35.7) • Not documented 8(57.1) 7(50) Ki67 • 20% 4(28.6) 3(21.4) • Not documented 9(64.3) 8(57.1) a Chi-square test was used. Discussion There is a growing trend towards using NAC in breast cancer treatment. This approach confers several advantages, including the facilitation of breast-conserving surgeries, eradication of axillary metastasis, and allowing in vivo assessments of tumor response to systemic therapies. In this study most of the in NAC group 13 (46.4%) received six cycles of chemotherapy. Since we have studied those patients retrospectively, demographic and clinical data were similarly distributed between NAC and upfront surgery groups. So, the two groups were roughly matched. In this study, the rate of metastasis in the upfront surgery group was significantly greater compared to the NAC group (P = 0.043). This finding indicating that neo-adjuvant therapy may effectively reduce the risk of metastasis by downstaging tumors before surgery. Conversely, our study found no significant difference in recurrence rates between the two groups (P = 0.353), which is consistent with findings from the meta-analysis of Mauri D et al who evaluated nine randomized studies, including a total of 3946 patients with breast cancer, that compared neoadjuvant therapy with adjuvant therapy, and reported similar recurrence rates regardless of treatment strategy. 14 However, the study of Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) reported that NAC was associated with more frequent local recurrence than was adjuvant chemotherapy. 12 A big body of evidence has grown over the last decade proving that the development of metastasis and local recurrence does not influenced by the type of surgery performed, as breast conservative surgery and mastectomy both has no difference in terms of metastasis and recurrence rate. 14 – 16 Similarly, this study demonstrated that, the development of metastasis and recurrence was not significantly affected by the types of surgery in the NAC (P value = 0.655) and upfront surgery groups (P value = 0.529). Regarding the survival rate, it was 50% in cases and 44.4% in controls. It is slightly lower than what has been reported by the first Sudanese study on survival outcome in breast cancer done by Muddather H et al, 17 which showed 58% overall survival for all breast cancer cases treated in the center. This difference would probably be due to the fact that they have included all disease stages including the early stages which has good survival rates. Nevertheless, our data is not far-away from the data reported by other developing countries in Africa such as Uganda (51.8%), and Ghana (47.9%). 18 In contrary higher rate of survival was reported in Indian (83%) by Akhtar M et al. 19 Furthermore, in this study, the 5-year overall survival rates were similar between groups (50% for NAC and 55.6% for upfront surgery; P = 0.454), indicating that both approaches may offer comparable long-term survival benefits. Kaplan-Meier survival analysis further supports these findings, revealing mean survival times of 74.1 (95% CI: 71.5 – 92.5) months for the NAC group and 82.0 (95% CI: 64.2 – 84.1) for the upfront surgery group, with no statistically significant difference (log-rank P = 0.973). These results are consistent with other studies those reported the survival benefits for patients with LABC who received either NAC or upfront surgeries were comparable. 9 , 12 , 20 – 24 The analysis also examined several biological markers and clinical factors, such as duration of symptoms, hormone receptor expression (ER/PR), HER2 status, and Ki67 levels. None of these factors significantly impacted the 5-year overall survival (P value > 0.05). Also, the 5-year mortality rate was higher in IDC grade-3 (n = 6; 42.9%) than in IDC grade-2 (n = 2; 14.3%), IDC grade-1 (n = 2; 14.3%) and ILC (n = 1; 7.1%) in the NAC group, but the differences was statistically insignificant (P value= 0.569). This finding suggests that tumor grade may play a role in patient outcomes but requires further investigation to establish definitive correlations. Several limitations must be acknowledged. Firstly, the sample size appears relatively small, which may limit the generalizability of the findings and reduce the power to detect significant differences in outcomes. Secondly, the retrospective nature of the study could introduce biases related to patient selection and treatment allocation. Future studies with larger cohorts and prospective designs are needed to validate these findings and better elucidate the role of neo-adjuvant therapy in breast cancer treatment. Conclusion In conclusion, while NAC appears to reduce metastasis rates compared to upfront surgery, both treatment strategies yield similar overall survival outcomes and recurrence rates in LABC. The lack of significant differences across various biological markers indicates that additional factors may influence patient prognosis and highlights the need for personalized treatment approaches based on individual patient characteristics and tumor biology. Future studies should aim to explore these relationships further and assess long-term outcomes in larger patient cohorts to refine treatment protocols effectively. Ethics statement Ethical approval was obtained from the General Surgery Institutional Review Board (IRB) at the Sudan Medical Specialization Board (SMSB) (02/2020), and performed following the ethical standards of the 1964 Declaration of Helsinki. 13 Consent to participate Both verbal and written consents to publish this information were gained from the patients. Transparency statement Tamador Elhadi Osman, the lead author, declares that this manuscript is an honest, accurate, and transparent. He also clarifies that significant aspects of this study were not excluded and any discrepancies from the planned study have been explicitly explained. Consent to publish All authors gave their approval for publication. Data availability The data consists of personal medical records of patients, and access is restricted to protect patient confidentiality. To apply for access to the data, readers or reviewers must submit a formal request including the purpose of the data use, a detailed research plan, and proof of ethical approval from a recognized institutional review board (IRB). Access will be granted only under the condition that the data will be used solely for the approved research purposes, and all necessary measures to ensure data privacy and security are in place. Applications should be directed to the corresponding author, and each request will be reviewed on a case-by-case basis. Underlying data Figshare: The Five-years Overall Survival and Recurrence Free Survival of Neoadjuvant Systemic Therapy in Breast Cancer Sudanese Patients: A Retrospective Comparative study: DOI: https://doi.org/10.6084/m9.figshare.27905544 . 25 The study contains the following data: • Raw data Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0). Extended data Figshare: The Five-years Overall Survival and Recurrence Free Survival of Neoadjuvant Systemic Therapy in Breast Cancer Sudanese Patients: A Retrospective Comparative study: DOI: https://doi.org/10.6084/m9.figshare.27905544 . 25 This project contains the following: • Questionnaire • Raw data Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0). References 1. Esraa S, Badria T, Salma S, et al. : Delays in presentation, diagnosis, and treatment in Sudanese women with breast cancer: a cross-sectional study. Oncologist. 2024; 29 (6): e771–e778. PubMed Abstract | Publisher Full Text | Free Full Text 2. Breast Cancer Outcomes in Sub-Saharan Africa: 2021. Accessed: 25/10/2024. Reference Source 3. Saeed IE, Weng HY, Mohamed KH, et al. : Cancer incidence in Khartoum, Sudan: First results from the cancer registry, 2009-2010. Cancer Med. 2014 Aug; 3 (4): 1075–1084. PubMed Abstract | Publisher Full Text | Free Full Text 4. Ali E, Moawia M: Personal perspective: Access to treatment for gynaecological malignancies in Sudan. South. Afr. J. Gynaecol. Oncol. 2018 Dec 1; 4 (2): 21–23. Publisher Full Text 5. Awadelkarim KD, Arizzi C, Elamin EO, et al. : Pathological, clinical and prognostic characteristics of breast cancer in Central Sudan versus Northern Italy: Implications for breast cancer in Africa. Histopathology. 2008; 52 : 445–456. PubMed Abstract | Publisher Full Text 6. Elgaili EM, Abuidris DO, Rahman M, et al. : Breast cancer burden in central Sudan. Int. J. Women’s Health. 2010; 2 : 77–82. Publisher Full Text 7. Elgaili EM, Abuidris DO, Rahman M, et al. : Breast cancer burden in central Sudan. Int. J. Women’s Health. 2010; 2 : 77–82. Publisher Full Text 8. Mohammed M, Mohammed A, Khalefa A, et al. : Diagnostic delay among symptomatic breast cancer patients: a study in Sudanese women. J. Prev. Med. Hyg. 2024; 65 : E403–E409. Publisher Full Text 9. Akbari ME, Ghelichi-Ghojogh M, Nikeghbalian Z, et al. : Neoadjuvant VS adjuvant chemotherapy in patients with locally advanced breast cancer; a retrospective cohort study. Ann. Med. Surg (Lond). 2022 Nov 84; 84 : 104921. PubMed Abstract | Publisher Full Text | Free Full Text 10. Cristina G, Fritz Lorenz E, Mark J, et al. : Survival Outcomes of Patients with Locally Advanced Breast Cancer after Neoadjuvant Systemic Therapy in St. Luke’s Medical Center. Asian Pac. J. Cancer Care. 2023; 8 (1): 83–95. Publisher Full Text 11. Klein J, Tran W, Watkins E, et al. : Locally advanced breast cancer treated with neoadjuvant chemotherapy and adjuvant radiotherapy: a retrospective cohort analysis. BMC Cancer. 2019; 19 : 306. PubMed Abstract | Publisher Full Text | Free Full Text 12. Early Breast Cancer Trialists’ Collaborative Group (EBCTCG): Long-term outcomes for neoadjuvant versus adjuvant chemotherapy in early breast cancer: meta-analysis of individual patient data from ten randomised trials. Lancet Oncol. 2018 Jan; 19 (1): 27–39. PubMed Abstract | Publisher Full Text | Free Full Text 13. Rickham PP: Human Experimentation. Code Of Ethics Of The World Medical Association. Declaration Of Helsinki. Br. Med. J. 1964 Jul 18; 2 (5402): 177. PubMed Abstract | Publisher Full Text | Free Full Text 14. Mauri D, Pavlidis N, Ioannidis JP: Neoadjuvant versus adjuvant systemic treatment in breast cancer: a meta-analysis. J. Natl. Cancer Inst. 2005 Feb 2; 97 (3): 188–194. PubMed Abstract | Publisher Full Text 15. Yu T, Tereffe W, Bedrosian I, et al. : Local-Regional Control According to Surrogate Markers of Breast Cancer Subtypes and Response to Neoadjuvant Chemotherapy in Breast Cancer Patients Undergoing Breast Conserving Therapy. Cancer Res. 2009; 69 (24_Supplement): 957–957. Publisher Full Text 16. Chou H, Chung W, Ding R, et al. : Factors affecting locoregional recurrence in breast cancer patients undergoing surgery following neoadjuvant treatment. BMC Surg. 2021; 21 (1): 113–160. PubMed Abstract | Publisher Full Text | Free Full Text 17. Muddather H, Elhassan M, Faggad A: Survival Outcomes of Breast Cancer in Sudanese Women: A Hospital-Based Study. JCO Glob. Oncol. 2021; 7 : 324–332. PubMed Abstract | Publisher Full Text | Free Full Text 18. Joko-Fru WY, Miranda-Filho A, Soerjomataram I, et al. : Breast cancer survival in sub-Saharan Africa by age, stage at diagnosis and human development index: A population-based registry study. Int. J. Cancer. 2020 Mar 1; 146 (5): 1208–1218. PubMed Abstract | Publisher Full Text | Free Full Text 19. Akhtar M, Akulwar V, Kulkarni A, et al. : Role of neo-adjuvant chemotherapy in locally advanced breast cancer. Indian J. Cancer. 2015; 52 (3): 286–289. PubMed Abstract | Publisher Full Text 20. Ghasemi F, Brackstone M: The Impact of Neoadjuvant versus Adjuvant Chemotherapy on Survival Outcomes in Locally Advanced Breast Cancer. Curr. Oncol. 2024; 31 (10): 6007–6016. PubMed Abstract | Publisher Full Text | Free Full Text 21. Cleator S, Makris A, Ashley S, et al. : Good clinical response of breast cancers to neoadjuvant chemoendocrine therapy is associated with improved overall survival. Ann. Oncol. 2005; 16 (2): 267–272. PubMed Abstract | Publisher Full Text 22. Huang K, Jakub J, Gabriel E, et al. : Overall Survival Following Neoadjuvant Chemotherapy Versus Adjuvant Chemotherapy in Clinically Node Negative T1 Triple Negative Breast Cancer. Ann. Surg. Oncol. 2023 Nov; 30 (12): 7026–7035. PubMed Abstract | Publisher Full Text 23. Yan C, Shi X, Jin-Hui T, et al. : Survival benefit of neoadjuvant chemotherapy for resectable breast cancer. Medicine. 2018; 97 (20): e10634. PubMed Abstract | Publisher Full Text | Free Full Text 24. Liu B, Song Y, Xu Y, et al. : Optimizing treatment sequence for inoperable locally advanced breast cancer: Long-term outcomes of surgery first versus neoadjuvant chemotherapy in a real-world setting. Int. J. Cancer. 2024; 156 : 368–378. PubMed Abstract | Publisher Full Text | Free Full Text 25. Amir O: The Five-years Overall Survival and Recurrence Free Survival of Neoadjuvant Systemic Therapy in Breast Cancer Sudanese Patients: A Retrospective Comparative study. Dataset. Figshare. 2024. Publisher Full Text Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 09 Jan 2025 ADD YOUR COMMENT Comment Author details Author details 1 General Surgery, Khartoum Teaching Hospital, Khartoum, Khartoum, 0000, Sudan 2 Faculty of Medicine, Al Neelain University, Khartoum, Khartoum, 0000, Sudan 3 General Surgery, Ibn Sina Specialized Hospital, Khartoum, Khartoum, 0000, Sudan 4 Hematology, Karary University, Omdurman, Khartoum, 0000, Sudan 5 Faculty of Medicine, University of Gezira, Wad Madani, Al Jazirah, 0000, Sudan Tamador Elhadi Osman Roles: Conceptualization, Funding Acquisition, Investigation, Methodology, Project Administration, Resources, Software, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Ayda Hussein Omer Mustafa Roles: Conceptualization, Investigation, Methodology, Project Administration, Resources, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Rayan Ali Abdalla Roles: Investigation, Methodology, Resources, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Osman Amir Roles: Data Curation, Formal Analysis, Methodology, Software, Writing – Original Draft Preparation, Writing – Review & Editing Hamid Ali Abd Alrahman Roles: Investigation, Methodology, Software, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (1) version 1 Published: 09 Jan 2025, 14:55 https://doi.org/10.12688/f1000research.159563.1 Copyright © 2025 Osman TE et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Osman TE, Mustafa AHO, Abdalla RA et al. The Five-years Overall Survival and Recurrence Free Survival of Neoadjuvant Systemic Therapy in Breast Cancer Sudanese Patients: A Retrospective Comparative study [version 1; peer review: 1 approved] . F1000Research 2025, 14 :55 ( https://doi.org/10.12688/f1000research.159563.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 1 VERSION 1 PUBLISHED 09 Jan 2025 Views 0 Cite How to cite this report: Tang H. Reviewer Report For: The Five-years Overall Survival and Recurrence Free Survival of Neoadjuvant Systemic Therapy in Breast Cancer Sudanese Patients: A Retrospective Comparative study [version 1; peer review: 1 approved] . F1000Research 2025, 14 :55 ( https://doi.org/10.5256/f1000research.175312.r364124 ) The direct URL for this report is: https://f1000research.com/articles/14-55/v1#referee-response-364124 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 18 Feb 2025 Hailin Tang , Sun Yat-sen University, Guangzhou, China Approved VIEWS 0 https://doi.org/10.5256/f1000research.175312.r364124 The title of the study is promising and could throw light on this field for future studies, but as potential points for improvement, the authors may consider the following items: Ensure consistency in the terminology used ... Continue reading READ ALL The title of the study is promising and could throw light on this field for future studies, but as potential points for improvement, the authors may consider the following items: Ensure consistency in the terminology used for genes and proteins throughout the manuscript and in the figures. A careful review of nomenclature will enhance clarity and reduce confusion for readers. It is advisable to validate the obtained results on additional datasets to ensure the robustness and generalizability of the findings. To make INTRODUCTION and DISSCUSSION parts more detailed about Neoadjuvant Systemic Therapy in Breast Cancer, these recent references (PMID: 34502549, 39748193) are advised to cited in the present manuscript. The manuscript contains several typographical and grammatical errors. Please revise the language carefully throughout the manuscript. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes References 1. An J, Peng C, Tang H, Liu X, et al.: New Advances in the Research of Resistance to Neoadjuvant Chemotherapy in Breast Cancer. Int J Mol Sci . 2021; 22 (17). PubMed Abstract | Publisher Full Text 2. Zhang J, Guan H, Song C, Liu L, et al.: Locoregional treatments of metastatic internal mammary node following neoadjuvant chemotherapy. Chin Med J (Engl) . 2025; 138 (3): 358-360 PubMed Abstract | Publisher Full Text Competing Interests: No competing interests were disclosed. Reviewer Expertise: Oncology research. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Tang H. Reviewer Report For: The Five-years Overall Survival and Recurrence Free Survival of Neoadjuvant Systemic Therapy in Breast Cancer Sudanese Patients: A Retrospective Comparative study [version 1; peer review: 1 approved] . F1000Research 2025, 14 :55 ( https://doi.org/10.5256/f1000research.175312.r364124 ) The direct URL for this report is: https://f1000research.com/articles/14-55/v1#referee-response-364124 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 09 Jan 2025 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 Version 1 09 Jan 25 read Hailin Tang , Sun Yat-sen University, Guangzhou, China Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Tang H. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 18 Feb 2025 | for Version 1 Hailin Tang , Sun Yat-sen University, Guangzhou, China 0 Views copyright © 2025 Tang H. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions The title of the study is promising and could throw light on this field for future studies, but as potential points for improvement, the authors may consider the following items: Ensure consistency in the terminology used for genes and proteins throughout the manuscript and in the figures. A careful review of nomenclature will enhance clarity and reduce confusion for readers. It is advisable to validate the obtained results on additional datasets to ensure the robustness and generalizability of the findings. To make INTRODUCTION and DISSCUSSION parts more detailed about Neoadjuvant Systemic Therapy in Breast Cancer, these recent references (PMID: 34502549, 39748193) are advised to cited in the present manuscript. The manuscript contains several typographical and grammatical errors. Please revise the language carefully throughout the manuscript. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes References 1. An J, Peng C, Tang H, Liu X, et al.: New Advances in the Research of Resistance to Neoadjuvant Chemotherapy in Breast Cancer. Int J Mol Sci . 2021; 22 (17). PubMed Abstract | Publisher Full Text 2. Zhang J, Guan H, Song C, Liu L, et al.: Locoregional treatments of metastatic internal mammary node following neoadjuvant chemotherapy. Chin Med J (Engl) . 2025; 138 (3): 358-360 PubMed Abstract | Publisher Full Text Competing Interests No competing interests were disclosed. Reviewer Expertise Oncology research. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) Tang H. Peer Review Report For: The Five-years Overall Survival and Recurrence Free Survival of Neoadjuvant Systemic Therapy in Breast Cancer Sudanese Patients: A Retrospective Comparative study [version 1; peer review: 1 approved] . F1000Research 2025, 14 :55 ( https://doi.org/10.5256/f1000research.175312.r364124) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. 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