Introduction: The rising incidence of breast cancer is a concern globally and 70% of cancer patients present at advanced stages in Cameroon. Neoadjuvant chemotherapy (NACT) has been shown to offer clinical benefits and objective pathologic response (OPR) to NACT is a potential surrogate marker of survival in some breast cancer subtypes. The prognostic value of OPR is unknown in Cameroon. We therefore sought to investigate the relationship between pathologic response to NACT and survival outcomes in breast cancer patients in Yaounde. Methodology: This was a historical cohort study from January 2019 to December 2023 at the Yaounde General and Central Hospitals of non-metastatic breast cancer patients with post-NACT pathological evaluation. Bivariate analysis and logistic regression were used to identify factors associated with OPR. Event-free and overall survival (EFS/OS) were compared using the Kaplan-Meier method and log-rank test. The association between pathologic response and survival outcomes was evaluated using Cox regression analysis and the likelihood ratio test. Results: This study included 119 female participants. Triple-negative breast cancer was the most common subtype (42.31%), and Doxorubicin/Cyclophosphamide plus a taxane (AC+taxane) was the most frequently used NACT protocol (53.78%). Good responders (complete/> 50% partial response) comprised 25.21% of the cohort, with a significantly better EFS compared to poor responders (41.91 ± 2.43 versus 19.86 ± 5.26 months, p = 0.01). Pathological response to NACT was not significantly associated to EFS (p = 0.79) or OS (p = 0.37). However, the use of AC plus taxane was independently associated with a longer EFS (HR: 0.23, p = 0.01) and OS (HR: 0.10, p = 0.00). Conclusion: The study reveals that pathologic response is not independently associated with survival outcomes. Instead, the use of a complete NACT by the AC + taxane protocol emerged as being independently associated to survival outcomes, informing treatment decisions and potentially improving patient outcomes.
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