The Neutrophil to Lymphocyte Ratio Predicts the Response to Neoadjuvant Chemotherapy in Luminal B Breast Cancer

Abstract

Objective: Tumor response to neoadjuvant chemotherapy (NAC) in breast cancer (BC) patients is a predictor for overall survival. The aim of our study was to determine a relationship between the neutrophil to lymphocyte ratio (NLR) prior to NAC, BC subtypes and the probability of a pathologic complete response (pCR). Materials and Methods: Medical records were collected retrospectively from Centro de Cancer at Red Salud UC-Christus. Clinical data collected included peripheral blood cell counts, BC subtype at diagnosis and the pathology report of surgery after chemotherapy. Results: A total of 88 patients were analyzed. Approximately, a 25% had a pCR, and displayed a significant correlation between BC subtype and pCR (p= 0.0138 Chi2); this was more frequent in epidermal growth factor receptor type 2 (HER2) enriched subtype patients (54%). Luminal B BC patients with a pCR had significantly lower NLR levels (t test, p= 0.0181). Conclusions: HER2-enriched tumors had a higher probability of pCR. In Luminal B tumors, NLR had a statistically significant relationship with the probability of pCR. In this subtype, NLR could be a useful biomarker to predict tumor response to NAC. Further studies including other clinical parameters for systemic inflammation such as platelet counts, intratumoral NLR or body mass index could help identify patients that would get the most benefit from NAC.

Is insulin resistance a predictor for complete response in breast cancer patients who underwent neoadjuvant treatment?

“…In a meta-analysis, a high NL ratio was shown to be statistically significantly associated with poor response to NAC in breast cancer patients [47]. Rivas and colleagues have shown the NL ratio might be a predictive biomarker for tumor response in luminal B breast cancer patients receiving neoadjuvant therapy [48]. Conversely, we did not find a statistically significant association between NLR, SII, and PLR and tumor response to neoadjuvant therapy.…”

Prognostic significance of the primary tumor site and immune indexes in patients with estrogen receptor-positive, human epidermal growth factor receptor-2-negative breast cancer

“…One of them found that NLR had a statistically significant relationship with the probability of PCR for luminal B subtype. While for the ER positive HER2 negative ones, PCR was not an independent feature for a better survival (34,35). After systematical and thorough analysis, maybe LMR is more suitable for the ER positive, HER2 negative subgroup.…”

A Rosetta Stone for Breast Cancer: Prognostic Value and Dynamic Regulation of Neutrophil in Tumor Microenvironment

“…In addition, since lymphocytes are critical in cancer immune surveillance and neutrophils have been reported to play a protumor role in most studies, low lymphocytes and high neutrophils in circulation may also suggest immunosuppression status ( 10 ), and studies focused on the relationship between neoadjuvant chemotherapy (NCT) and the NLR might support the above hypothesis. A comprehensive review of the existing reports shows that most studies have found that a low NLR indicates a higher NCT response and pathological complete response (pCR) rate ( 25 – 27 ); in addition, the NLR has showed predictive value not only in all molecular types of BC but also in both operable and locally advanced BC ( 18 , 28 , 29 ). Interestingly, although Suppan et al did not find a significant correlation between the initial NLR and prognosis, the same cohort revealed a low NLR as a significant parameter for predicting chemotherapy response ( p = 0.012) ( 23 ).…”