Pre-treatment Serum Cortisol as a Predictor of Chemotherapy Outcomes: Improving Clinical Evidence for Advanced Breast Cancer Care

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Published Oct 29, 2026
https://doi.org/10.25077/jom.11.1.38-49.2026
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Vol. 11 No. 1 (2026): Published on June 2026

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Andy Achmad Suanda
Medical Doctor Profession, School of Medicine, Universitas Ciputra Surabaya, East Java, Indonesia
Heru Purwanto
Department of Surgery, Oncology Division, Dr.Saiful Anwar General Hospital, Malang, East Java, Indonesia
Paul L Tahalele
Medical Doctor Profession, School of Medicine, Universitas Ciputra Surabaya, East Java, Indonesia

Abstract

An appropriate diagnosis and management strategy for breast cancer require accurate predictive biomarkers for improved treatment results. The present research seeks to explore the effectiveness of pre-treatment cortisol blood levels in predicting the clinical outcome of anthracycline neoadjuvant chemotherapy in patients with breast cancer at stage III. In a prospective cohort study with a sample size of 64 patients, the concentration of morning cortisol was measured before starting the FAC/CEF treatment, and the clinical results were measured using the RECIST 1.0 criteria and verified through bootstrap resampling. The statistical analysis showed that cortisol concentration above the optimal threshold of 498 nMol/L is positively associated with chemoresistance, with an Odds Ratio of 28.6 (p < 0.001). The ROC curve analysis supported the optimal prediction threshold with an AUC of 0.89, showing a higher level of accuracy than standard clinicopathological factors. Using the cortisol measurement test in the clinical setting allows the identification of high-risk patients to initiate personalized stress management and improve the treatment response. The findings help achieve Sustainable Development Goal 3.

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