Risk Factors Influencing Efficacy and Prognosis Evaluation of Neoadjuvant Systemic Therapy in Triple‐Positive Breast Cancer

To identify the determinants of the response to neoadjuvant systemic therapy (NST) in triple‐positive breast cancer (TPBC), we retrospectively enrolled 520 patients with human epidermal growth factor receptor 2 (HER2)‐positive breast cancer who were treated at The First Affiliated Hospital of Chongqing Medical University between January 2015 and December 2021. The cohort comprised 299 cases of TPBC and 221 cases of hormone receptor (HR)‐negative/HER2‐positive breast cancer (HPBC). A comparative analysis revealed that the pathological complete response (pCR) rate was significantly lower in the TPBC group than in the HPBC group (30.1% vs. 50.2%; p < 0.001); however, this differential response did not translate into a significant difference in long‐term survival. Within the TPBC cohort, pCR was identified as an independent prognostic factor for prolonged disease‐free survival (DFS) ( p = 0.014). Multivariate analysis further revealed that the NST regimen ( p = 0.001), estrogen receptor (ER) status ( p = 0.024), and Ki67 index ( p = 0.018) were independent predictors of pCR. A nomogram incorporating these factors was developed using R software to estimate the individual probability of pCR in TPBC. The model was externally validated in an independent cohort of 143 TPBC patients treated between January 2022 and December 2024, and the results demonstrated robust predictive performance and good calibration. This model serves as a tool for early risk stratification in TPBC, thereby facilitating personalized treatment strategies and risk‐adapted surveillance to improve patient outcomes.