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Background <p>Pathological complete response (pCR) after neoadjuvant chemotherapy (NACT) is a surrogate for long-term outcomes in breast cancer, yet response rates vary widely. Biomarkers are needed to predict efficacy. Vitamin D, through its receptor-mediated diverse biological effects on tumor biology and immune regulation, has been suggested as a potential predictor of pCR.</p> Methods <p>We retrospectively evaluated breast cancer patients who received NACT between December 2022 and December 2024. Baseline serum vitamin D and inflammatory indices, including neutrophil-to-lymphocyte ratio (NLR), C-reactive protein/albumin ratio (CAR), prognostic nutritional index (PNI), and atherogenic index of plasma (AIP), were assessed. Pathological response was defined as pCR or Miller–Payne grades 4–5. ROC analysis identified optimal cut-offs, and logistic regression was applied to explore factors associated with pathological response.</p> Results <p>Among 223 patients, pCR occurred in 39.0%. ROC analysis identified 14.5&#xa0;ng/mL as the optimal vitamin D threshold (AUC 0.705, <i>p</i> &lt; 0.001). Vitamin D ≥ 14.5&#xa0;ng/mL was independently associated with higher response, particularly in HR + /HER2 − and HER2 + subtypes; multivariable analyses also supported significance in TNBC. Recent vitamin D supplementation before NACT was significantly correlated with improved outcomes. Elevated CAR and AIP were inversely associated with response.</p> Conclusions <p>Vitamin D levels above 14.5&#xa0;ng/mL independently predicted superior pathological response to NACT, with subtype-specific effects. Both baseline status and supplementation may enhance chemosensitivity, supporting vitamin D as a clinically relevant predictive biomarker.</p>

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Impact of vitamin D deficiency and inflammatory biomarkers on pathological response to neoadjuvant chemotherapy in breast cancer

  • 期刊论文

  • 发表日期：

    2026年1月12日

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  • Kadriye Başkurt,
  • Galip Can Uyar,
  • Enes Yeşilbaş,
  • Orhun Akdoğan,
  • Tuba Ugur Tuzcu,
  • Ömür Berna Çakmak Öksüzoğlu,
  • Kadriye Bir Yücel,
  • Osman Sütcüoğlu

摘要

Background

Pathological complete response (pCR) after neoadjuvant chemotherapy (NACT) is a surrogate for long-term outcomes in breast cancer, yet response rates vary widely. Biomarkers are needed to predict efficacy. Vitamin D, through its receptor-mediated diverse biological effects on tumor biology and immune regulation, has been suggested as a potential predictor of pCR.

Methods

We retrospectively evaluated breast cancer patients who received NACT between December 2022 and December 2024. Baseline serum vitamin D and inflammatory indices, including neutrophil-to-lymphocyte ratio (NLR), C-reactive protein/albumin ratio (CAR), prognostic nutritional index (PNI), and atherogenic index of plasma (AIP), were assessed. Pathological response was defined as pCR or Miller–Payne grades 4–5. ROC analysis identified optimal cut-offs, and logistic regression was applied to explore factors associated with pathological response.

Results

Among 223 patients, pCR occurred in 39.0%. ROC analysis identified 14.5 ng/mL as the optimal vitamin D threshold (AUC 0.705, p < 0.001). Vitamin D ≥ 14.5 ng/mL was independently associated with higher response, particularly in HR + /HER2 − and HER2 + subtypes; multivariable analyses also supported significance in TNBC. Recent vitamin D supplementation before NACT was significantly correlated with improved outcomes. Elevated CAR and AIP were inversely associated with response.

Conclusions

Vitamin D levels above 14.5 ng/mL independently predicted superior pathological response to NACT, with subtype-specific effects. Both baseline status and supplementation may enhance chemosensitivity, supporting vitamin D as a clinically relevant predictive biomarker.