Combined peripheral neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio as a predictive biomarker for pathological complete response after neoadjuvant chemotherapy in triple-negative breast cancer patients

Background: Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have recently been used as prognostic markers in several tumors particularly more studied in gastrointestinal cancers. Impact of these markers on breast cancer is less studied. We evaluated the correlation of pretreatment NLR and PLR with pathological complete response (pCR) rate to neoadjuvant chemotherapy (NACT) treatment in triple-negative breast cancer (TNBC) patients in addition to analyze the association of these parameters with other clinicopathological parameters. Materials and Methods: Seventy-four early or locally advanced TNBC patients who received NACT and subsequent breast surgery from January 2018 to December 2020 were analyzed. Complete blood profiles done within 1 week of start of NACT were recorded and NLR and PLR were calculated. Pathological responses to NACT after surgery were recorded. The correlation of NLR and PLR with pCR rate and other clinicopathological parameters were evaluated. Results: The median age of presentation was 47 years. Eighteen patients (24.3%) had achieved pCR in this study. The pCR rate was higher in patients with low pre-treatment NLR (≤2.2) versus high NLR (>2.2) (P = 0.038) and low pre-treatment PLR (≤195.8) versus high PLR (>195.8) (P = 0.039). Both the pretreatment NLR and PLR values had no significant association with other clinicopathological profiles such as age, menopausal status, histopathological types and grade of differentiation, and initial clinical stage whereas there is an increase trend of ≤50 years of age group presentation in low NLR/PLR patients. On multivariate analysis, pre-NACT NLR and PLR were found to be independent predictive biomarker for pCR in TNBC patients. Conclusion: The study observed that the pre-NACT NLR and PLR are an indicator of pCR to NACT in TNBC unfolding its potential in future as a cost-effective prognostic and predictive biomarker.