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This study evaluates the surrogacy value of distant disease-free survival (DDFS) as a predictor for overall survival (OS) in neoadjuvant therapy trials for early breast cancer. The analysis of 11 randomized controlled trials involving 12,247 patients showed a strong association between treatment effects on OS and DDFS, with an R²trial value of 0.91, indicating robust surrogacy in most contexts, except for hormone receptor-positive and HER2-positive subtypes. The findings suggest that DDFS can reliably predi

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