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

Resumo

Objective: To evaluate the role of neutrophil-to-lymphocyte ratio (NLR) in predicting survival after neoadjuvant chemotherapy. Methods: This retrospective review analyzed data from medical records of 692 patients who underwent neoadjuvant chemotherapy for early-stage TNBC (II–III), from 2012 to 2024. NLR was calculated from the complete blood count
before neoadjuvant chemotherapy initiation, and the cut-off point used was 2. Event-free survival and overall survival
were estimated with the Kaplan-Meier method, and Cox regression model was employed to calculate the hazard ratios
(HR). Logistic regression was used to verify the association between NLR and pathological complete response (pCR).
Results: The overall pCR rate was 28.3%, and patients with NLR≤2 had an increased probability of achieving pCR (33%
vs. 22.7%; p=0.002). After a median follow-up of 59.6 months, NLR≤2 was associated with improved 5-year event-free
survival in the overall population (51% vs. 66%; HR 0.59; p<0.001), in patients with stage II disease (69% vs. 81%; HR 0.49;
p=0.010), stage III (43% vs. 55%; HR 0.70; p=0.010), and residual disease (42% vs. 54%; HR 0.65; p=0.001). Overall survival
of 5 years was also improved in the overall population with NLR≤2 (58% vs. 73%; HR 0.56; p<0.010), stage II disease (75%
vs. 86%; HR 0.42; p=0.009), stage III disease (50% vs. 62%; HR 0.68; p=0.015), and in patients with residual disease (50% vs.
64%; HR 0.62; p=0.001). In multivariate analysis, including pCR status and clinical stage, NLR≤2 remained statistically
significant for improved overall survival (p=0.002) and event-free survival (p=0.002). Conclusion: NLR>2 is an independent risk factor for poorer survival in patients with TNBC who received neoadjuvant chemotherapy.