Neutrophil-to-lymphocyte ratio predicts long-term survival in early triple negative breast cancer treated with neoadjuvant chemotherapy.

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.