Background: The accurate assessment of residual tumor tissue after neoadjuvant chemotherapy (NAC) for breast cancer is closely related to the subsequent treatment and prognosis of patients. The objective of this study is to develop a new pathological assessment metric for breast cancer patients through combining residual disease in breast and nodes (RDBN) and the Ki-67 expression status after NAC. We call the new metric residual disease in breast and nodes combined with Ki-67 (RDBN-K) and aim to study its significance for prognosis. Methods: A total of 723 breast cancer patients with TNM staging II to III who received NAC and surgical treatment underwent residual disease evaluation by RDBN-K and RDBN. All patients were followed up for a median of 44 months. We used pairwise stratified analysis to compare the accuracy and clinical significance of the RDBN and RDBN-K. Results: Pairwise stratified analysis revealed that DFS and OS had larger difference between RDBN-K-3 and RDBN-K-4 compared to between RDBN-3 and RDBN-4. Moreover, RDBN-K also showed larger differences in OS between stage 2 and 3 compared to RDBN alone. Conclusions: Incorporating Ki-67 expression status into RDBN improved the accuracy in residual tumor burden assessment after NAC. RDBN-K is a better metric for predicting treatment outcomes and identify patients who warrant follow-up intensive treatment.