Which Labarotory Index is Better for Predicting Survival and Pathological Response in Patients with Breast Cancer Receiving NACT?

Abstract

Objective: Neoadjuvant chemotherapy (NACT) is the standard treatment for locally advanced, high-risk breast cancer. Pathological complete response (pCR) improves survival. Peripheral blood-derived indices reflecting systemic inflammation and nutritional status have long been used as predictive and prognostic markers in solid malignancies. This retrospective study investigates whether eight commonly used indices in patients receiving NACT effect on pCR and survival. Methods: This study includes 624 patients with locally advanced breast cancer who received NACT. The biomarker indices were calculated from peripheral blood samples taken two weeks before starting chemotherapy. Optimal cut-off values of the indices were determined using ROC Curve analysis. Results: During a median follow-up period of 42 months, recurrence was detected in 146 patients, and 75 patients died. pCR was observed in 166 patients (26.6%). In univariate analysis, NLR, PLR, SII, PNI, HALP, and HRR were statistically significantly associated (p=0.00; p=0.03; p=0.03; p=0.02; p=0.00; p=0.02 respectively), but in multivariate analysis, only NLR was significantly predictive for pCR(p=0.04). Inn multivariate analysis, the HGB/RDW score significantly predicted DFS(p=0.04). The PNI score was identified as a marker predicting survival for both OS and PFS(p=0.01, p=0.01, respectively). Conclusion: In conclusion, peripheral blood-derived indices have prognostic and predictive values on pCR and survival. However, further studies are needed to validate our findings.