Objective To investigate the efficacy and influencing factors of programmed death-1 (PD-1) inhibitors in neoadjuvant chemotherapy for triple-negative breast cancer (TNBC). Methods A total of 86 patients with TNBC who received neoadjuvant therapy in The Fifth Medical Center, PLA General Hospital between Jan. 1, 2018, and Jan. 1, 2024 and met the inclusion criteria were enrolled, and their clinicopathological data were collected. Based on the neoadjuvant treatment regimens, 40 patients who received TP＋PD-1 inhibitor (paclitaxel＋carboplatin＋pembrolizumab) were assigned to TP＋PD-1 inhibitor group, and 46 patients who received TP (paclitaxel＋carboplatin) were assigned to TP group. The efficacy and incidence of adverse events were compared between the 2 groups after 6 cycles of neoadjuvant therapy. According to the efficacy of neoadjuvant therapy, the patients were further categorized into pathological complete response (pCR) group and non-pCR group. Multivariate logistic stepwise regression analysis was performed to identify independent factors influencing neoadjuvant treatment efficacy. Patients were followed up until Dec. 31, 2024, and survival analysis was conducted using Kaplan-Meier method. Results There was no significant difference in the objective response rates between the TP＋PD-1 inhibitor group and TP group after neoadjuvant therapy (95.0% [38/40] vs 91.3% [42/46], P＝0.351]. However, the pCR rate was significantly higher in the TP＋PD-1 inhibitor group compared with the TP group (65.0% [26/40] vs 43.5% [20/46], P＝0.047). There were no significant differences between the 2 groups in terms of disease-free survival, overall survival, or incidence of adverse events (all P＞0.05). Multivariate logistic stepwise regression analysis revealed that the expression of Ki-67 and treatment regimen were influencing factors of pCR after neoadjuvant therapy (odds ratio [OR]＝3.382, 95% confidence interval [95%CI] 1.290-8.868, P＝0.013; OR＝2.524, 95%CI 1.013-6.285, P＝0.047). One case of distant metastasis and death occurred in the pCR group, while 8 cases of distant metastasis and 4 deaths occurred in the non-pCR group. The disease-free survival was significantly longer in the pCR group than in the non-pCR group (P＝0.031), while the overall survival was similar between the 2 groups (P＝0.087). Conclusion Compared with the 6-cycle TP regimen, the 6-cycle TP combined with PD-1 inhibitor regimen can improve the pCR rate in the neoadjuvant treatment of TNBC, with manageable adverse events, suggesting it may serve as a preferred option for TNBC neoadjuvant therapy. Ki-67 expression may serve as a predictive biomarker for achieving pCR. TNBC patients who achieved pCR have better disease-free survival than those who did not.