Derived Neutrophil-to-Lymphocyte Ratio Predicts Pathological Complete Response to Neoadjuvant Chemotherapy in Breast Cancer

Abstract

BackgroundDerived neutrophil-to-lymphocyte ratio (dNLR) is a biomarker associated with clinical outcome in breast cancer (BC). We analyzed the association of dNLR with pathological complete response (pCR) in triple-negative BC (TNBC) patients receiving neoadjuvant chemotherapy (CT).MethodsThis is a retrospective analysis of two randomized studies involving early stage/locally advanced TNBC patients receiving anthracycline/taxane-based CT+/−carboplatin (GEICAM/2006-03) or nab-paclitaxel/paclitaxel followed by anthracycline regimen (ETNA). dNLR was calculated as the ratio of neutrophils to the difference between total leukocytes and neutrophils in peripheral blood before CT (baseline) and at the end of treatment (EOT). Logistic regression analyses were used to explore dNLR association with pCR.ResultsIn total, 308 TNBC patients were analyzed, 216 from ETNA and 92 from GEICAM/2006-03. Baseline median dNLR was 1.61 (interquartile range (IQR): 1.25–2.04) and at EOT 1.53 (IQR: 0.96–2.22). Baseline dNLR showed positive correlation with increased tumor size (p-value = 1e−04). High baseline dNLR, as continuous variable or using median cutoff, was associated with lower likelihood of pCR in univariate analysis. High EOT dNLR as continuous variable or using quartiles was also associated with lower pCR rate in uni- and multivariate analyses.ConclusionsHigh baseline and EOT dNLR correlates with lower benefit from neoadjuvant CT in TNBC.

Low neutrophil-to-lymphocyte ratio and pan-immune-inflammation-value predict nodal pathologic complete response in 1274 breast cancer patients treated with neoadjuvant chemotherapy: a multicenter analysis

“…32 When specific subsets of BC were explored, NLR provided additional information regarding the likelihood of obtaining a pCR to NAC in postmenopausal Luminal B/HER2positive 33 and triple-negative BC. 34 Studies on other blood cell ratios such as platelet to lymphocyte ratio and monocyte to lymphocyte ratio showed conflicting results about their value as a predictive and/or prognostic factor and there are conflicting reports about which index provides the best prediction for the efficacy of NAC in BC. 35 However, it has been hypothesized that the combination of multiple biomarkers could better define the patients' inflammatory status.…”

Low neutrophil-to-lymphocyte ratio and pan-immune-inflammation-value predict nodal pathologic complete response in 1274 breast cancer patients treated with neoadjuvant chemotherapy: a multicenter analysis

“…Another subsequent meta-analysis on 19 studies, con rmed this result (OR 1.6, 95% CI, 1.2-2.1, I 2 66%, p > 0.001) 30 . When speci c subsets of BC were explored, NLR provided additional information regarding the likelihood of obtaining a pCR to NAC in postmenopausal Luminal B/HER2 positive 31 and in triple negative BC 32 .…”

A real‐world study of immune checkpoint inhibitors in advanced triple‐negative breast cancer

“…In NSCLC patients treated with ICIs, high dNLR was associated with poorer PFS (HR = 1.56; p < 0.0001) and OS (HR = 2.02; p < 0.0001) [ 36 ]. A study including 308 patients with early/locally advanced TNBC explored the relationship between dNLR and pCR and found that a high dNLR at baseline might be associated with a lower pCR rate [ 37 ]. Similarly, this study found that patients with lower dNLR had longer PFS and OS.…”