Low neutrophil-to-lymphocyte ratio and pan-immune-inflammation-value predict nodal pathologic complete response in 1274 breast cancer patients treated with neoadjuvant chemotherapy: a multicenter analysis

Abstract

Background Systemic inflammatory markers draw great interest as potential blood-based prognostic factors in several oncological settings. The aim of this study is to evaluate whether neutrophil-to-lymphocyte ratio (NLR) and pan-immune-inflammation value (PIV) predict nodal pathologic complete response (pCR) after neoadjuvant chemotherapy (NAC) in node positive (cN+) breast cancer (BC) patients.Methods Clinically node-positive BC patients undergoing NAC followed by breast and axillary surgery were enrolled in a multicentric study from 11 Breast Units. Pre-treatment blood counts were collected for the analysis and used to calculate NLR and PIV. Logistic regression analyses were performed to evaluate independent predictors of nodal pCR.Results A total of 1274 cN + BC patients were included. Nodal pCR was achieved in 586 (46%) patients. At multivariate analysis, low NLR (OR = 0.71; 95% CI, 0.51–0.98; p-value = 0.04) and low PIV (OR = 0.63; 95% CI, 0.44–0.90; p-value = 0.01) were independently predictive of increased likelihood of nodal pCR. A sub-analysis on cN1 patients (n = 1075), confirmed the statistical significance of these variables. PIV was significantly associated with axillary pCR in ER-/HER2+ (OR = 0.31; 95% CI, 0.12–0.83; p-value = 0.02) and ER-/HER2- (OR = 0.41; 95% CI, 0.17–0.97; p-value = 0.04) BC patients.Conclusion This study found that low NLR and PIV levels predict axillary pCR in patients with BC undergoing NAC.Trial registration Eudract number NCT05798806