Prognostic value of the pretreatment neutrophil-to-lymphocyte ratio in different phenotypes of locally advanced breast cancer during neoadjuvant systemic treatment

Abstract Purpose Neutrophils are among the key cellular players in the inflammatory milieu produced in BC patients, and strong evidence exists in terms of the prognostic value of assessing the neutrophil to lymphocyte ratio (NLR) in BC patients. In this study we sought to determine whether the baseline NLR correlates with pathological complete response (pCR), disease-free survival (DFS) and overall survival (OS) in locally-advanced BC patients in the neoadjuvant chemotherapy (NAC) setting. Methods We analyzed the pre-treatment NLR from the first blood count of patients treated from 2007-2015 in terms of pCR, DFS and OS in locally-advanced BC patients. Patients received standard medical care based on national guidelines. Results A total of 1519 patients were included in the study. Median age was 49 years (22-88). The cut-off point for NLR was 2.0. NLR was not associated with pCR or DFS. However, patients with high NLR had worse OS in the presence of Triple-Negative BC (105.9 months [95%CI 100.2-111.5] vs. 98.7 months [95%CI 91.1-106.3]; p=0.029), Her2-overexpression (114.0 months, [95%CI 110.5-118.0] vs. 100.8 months, [95%CI 95.7-105.9]; p=0.019), and residual disease after NAC for both phenotypes. Multivariate analysis showed that NLR was independently associated with OS (HR 1.4, [95%CI: 1.02-1.95]; p=0.037). Conclusions Pretreatment NLR in patients with locally-advanced BC correlates with OS as an independent prognostic factor. This influence depends on phenotype and residual disease. Routine assessment of this parameter could be an easy and affordable tool for defining prognosis.