Novel peripheral blood parameters as predictors of neoadjuvant chemotherapy response in breast cancer

Abstract

The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune severity index (SII), and prognostic nutritional index (PNI) are associated with the prognosis of gastric, lung, and breast cancers. However, the predictive value of pathological complete response (pCR) rates in patients with breast cancer treated with neoadjuvant chemotherapy (NAC) remains unclear. This retrospective study explored the correlation between each index and the efficacy of neoadjuvant chemotherapy in patients with breast cancer and assessed the relationship between changes before and after neoadjuvant chemotherapy. We enrolled 95 patients with locally advanced breast cancer who received neoadjuvant therapy for breast cancer at the Second Affiliated Hospital of Fujian Medical University from April 2020 to April 2022. Based on postoperative pathology, patients were divided into pCR and non-pCR groups. Between-group differences and efficacy prediction ability of NLR, PLR, SII, and PNI were analyzed. Patient characteristics and changes in NLR, PLR, SII, and PNI before and after neoadjuvant chemotherapy (NAC) were compared between groups. Patients were divided into two groups according to the optimal diagnostic thresholds of the SII before treatment. Between-group differences in terms of neoadjuvant therapy efficacy and patient characteristics were evaluated. The pCR exhibited significantly lower ER (χ2 = 10.227, P = 0.001), PR (χ2 = 3.568, P = 0.049), pretreatment NLR (χ2 = 24.930, P < 0.001), pretreatment PLR (χ2 = 22.208, P < 0.001), pretreatment SII (χ2 = 26.329, P < 0.001), and post-treatment PNI (P = 0.032), but higher HER-2 (χ2 = 7.282, P = 0.007) and ΔNLR (P = 0.015) than the non-pCR group. ROC curve analysis revealed that the areas under the curve (AUC) of pretreatment SII, NLR, and PLR for predicting pCR of NAC for breast cancer were 0.827, 0.827, and 0.810, respectively, indicating a higher predictive value for response to NAC in patients with breast cancer. According to the Youden index, the optimal cut-off value of SII pretreatment was 403.20. Significant differences in age (χ2 = 6.539, P = 0.01), ER (χ2 = 4.783, P = 0.029), and HER-2 (χ2 = 4.712, P = 0.030) were observed between high and low-SII groups. In conclusion, pretreatment NLR, PLR, and SII can be used as predictors of pCR in patients with breast cancer receiving neoadjuvant chemotherapy. The predictive value of pretreatment SII is higher, and patients with low SII are more likely to achieve pCR.

Prognostic significance of platelet-to-lymphocyte ratio (PLR) in patients with breast cancer treated with neoadjuvant chemotherapy: a meta-analysis

“…Nineteen studies with 4301 patients reported the correlation between the PLR and pCR 22 26 28 32–40 42–47. Our results indicate that high PLR level was significantly associated with low pCR rate (HR 0.77, 95% CI 0.67 to 0.88, p<0.001), and significant heterogeneity was observed (I 2 =75.80%, P h <0.001, table 1, figure 1).…”

“…Different studies use variant cut-off values from different methods. Traditionally, we believe that the ROC curve is the most suitable for getting the optimal cut-off value 33 41 43 46 47. However, other studies have also achieved significant results using the cut-off values from previous studies 26 28 34.…”

The role of laboratory indices on treatment response and survival in breast cancer receiving neoadjuvant chemotherapy

“…Another study involving over 1100 patients found that pre-treatment PNI was a reliable predictor of pCR in breast cancer patients 54 . However, in the study by Yang et al, it was observed that pCR was not a predictive marker in breast cancer patients receiving PNI and NACT 55 . Lastly, a study by Oba T. divided patients receiving NACT into two groups based on their PNI before treatment.…”

Early changes of platelet‑lymphocyte ratio correlate with neoadjuvant chemotherapy response and predict pathological complete response in breast cancer

“…Earlier studies have shown that markers of inflammation, like NLR and PLR, could potentially serve as predictive factors for pCR following NACT in breast cancer (10)(11)(12)(16)(17)(18). Nevertheless, while these studies primarily examined the initial or pre-treatment condition of inflammatory markers, only a limited number of studies assessed the changes of inflammatory markers throughout or following the treatment.…”