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We evaluated central nervous system (CNS) recurrence patterns in early-stage BC following NAC according to pCR.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>All consecutive stage I\u2013III BC treated with NAC and surgery at a single center between 2007 and 2018 were analyzed. Endpoints included the impact of pCR on CNS recurrence across BC subtypes\u2014hormone receptor-positive(HR)\/HER2-negative, HER2-positive and triple-negative (TNBC), CNS recurrence patterns and overall survival (OS) after CNS relapse. Statistical comparisons included Fisher\u2019s Exact test, Chi-square, Kaplan\u2013Meier, and regression analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 1147 patients, 537 had HR-positive\/HER2-negative, 301 HER2-positive, 309 TNBC, mostly stage III, treated with anthracycline\u2009+\u2009taxane NAC, and trastuzumab if HER2-positive. Three hundred sixty-five achieved pCR (59\/537 HR-positive\/HER2-negative, 158\/301 HER2-positive, 148\/309 TNBC). CNS recurrence occurred in 72 (6.2%) patients, with no difference between pCR and non-pCR (4.7 vs. 7.0%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.15). Across subtypes, there was no difference for HR-positive\/HER2-negative (3.4 vs. 4%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20091.0), TNBC (5.4 vs. 9.3%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.2), however there was a reduction in HER2-positive (4.4 vs. 14.7%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.003) after pCR. Isolated CNS relapse was the predominant pattern of CNS metastasis (82.4%) in pCR, particularly in HER2-positive. Median OS after CNS relapse was 12\u00a0months. Multivariate analysis identified HER2-positive, TNBC, and cN2\u20133 status as independent predictors of CNS recurrence.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Although pCR was not associated with a lower overall risk of CNS recurrence, it predicted a reduced risk in HER2-positive disease. Isolated CNS relapse predominated, suggesting a sanctuary effect.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10549-026-07915-7","type":"journal-article","created":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T00:57:57Z","timestamp":1774227477000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Risk of CNS relapse following pathological complete response to neoadjuvant chemotherapy in early breast cancer"],"prefix":"10.1007","volume":"216","author":[{"given":"Luciana","family":"de Moura Leite","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guilherme Rossato","family":"de Almeida","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Monique Celeste","family":"Tavares","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marcelle Goldner","family":"Cesca","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fernando Augusto Batista","family":"Campos","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fernanda Alves","family":"de Oliveira","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Debora Maciel Santana","family":"Dornellas","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erick F.","family":"Saldanha","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paula Tavares","family":"Guimar\u00e3es","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniella Dias S\u00e1","family":"de Arruda","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Fernanda Sim\u00f5es Devides","family":"de Held","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rafael Lima","family":"Viana","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francisca Giselle Rocha","family":"Moura","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simone Klug","family":"Loose","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sinara Figueiredo","family":"Silva","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rafaela","family":"Pirolli","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Camilla Albina Zanco","family":"Fogassa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bruna Raphaeli Silva","family":"Mattos","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Solange Moraes","family":"Sanches","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vladmir C. 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