Background: Breast cancer in young women is one of the leading causes of cancer death in young women worldwide, including in Indonesia. Most patients come to the hospital at the advanced stage. Neoadjuvant chemotherapy (NAC) is the standard treatment for locally advanced breast cancer. However, half of breast cancer patients had a negative response to therapy.   Methods: A retrospective cohort, analytic observational study to determine the association between NLR and anthracycline-based NAC clinical response in locally advanced young age breast cancer in Dr. Soetomo General Hospital, Surabaya. Results: We analyze a total of 44 patients. 81.8% had stage IIIB, 93.2% >50 mm tumor size. Most of the cases had invasive ductal carcinoma type (86.4%), grade 3 (52.3%), and Luminal B HER2-negative type (34.1%). 52.3% of patients had a negative clinical response. The mean NLR was 3.07 ± 1.69, with a cut-off value of 2.805. There was no significant association between age, tumor size, histopathological type, grade, and subtype with neoadjuvant chemotherapy clinical response. There was a significant relationship between NLR with anthracycline-based NAC clinical response in locally advanced young age breast cancer (p < 0.001). Conclusion: There was a significant relationship between NLR with the anthracycline-based neoadjuvant chemotherapy clinical response in young women with LABC.

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