Purpose: Biomarkers for tailoring treatment in neoadjuvant triple-negative breast cancer (TNBC) are needed. We hypothesize that neutrophil-to-lymphocyte ratio (NLR) before neoadjuvant chemotherapy (NACT) can predict long-term outcomes in this population.
Methods: We reviewed our institutional database to identify patients with clinical stages II–III TNBC who underwent NACT from 2012 to 2024 and retrospectively collected data from medical records. We calculated event-free survival (EFS) from the date of NACT initiation until death, disease recurrence or disease progression that precluded surgery; we calculated overall survival (OS) from the date of NACT initiation until death. Survival estimates were analysed using Kaplan–Meier method and compared with log rank test. The Cox regression model was used to calculate hazard ratios.
Results: A total of 692 patients were included in the analysis. Of these, 63.3% had stage III disease, 60.8% had grade 3 tumours and 77.2% had a Ki-67 >50%. The most common NACT regimen used was anthracycline and taxane-based (96.8%). The overall pathological complete response (pCR) rate was 27.7%. After median follow-up of 59.6 months, NLR >2 was associated with poorer EFS (HR 1.71, 95% CI 1.33–2.18, p < 0.001) and OS (HR 1.76, 95% CI 1.34–2.31, p < 0.001). The results maintained statistical significance after adjusting for age, ki67, clinical stage and pCR status (p = 0.002).
Conclusion: NLR predicts long-term survival after NACT in TNBC and, as a readily and inexpensive information, should be further studied in current approaches of chemoimmunotherapy.
