Inflammatory markers as predictors of pathological complete response in patients with breast cancer after neoadjuvant chemotherapy.

Abstract

e12653 Background: Breast cancer is the most common cancer and the leading cause of cancer-related death in women. Pathological complete response (pCR) is associated with better overall survival and progression-free survival. Inflammation plays an important role in the occurrence and development of tumors, and in previous studies there is information that inflammatory markers such as the neutrophil-lymphocyte ratio (NLR), the lymphocyte-monocyte ratio (LMR), the platelet-lymphocyte ratio (PLR), the absolute lymphocyte count (ALC), the systemic inflammatory response index (SIRI), the systemic immune inflammation index (SII) and even the body mass index (BMI) can predict response in different types of cancer. The present study evaluated the expression of these inflammatory markers in breast cancer patients who received neoadjuvant chemotherapy to determine their potential as predictive biomarkers of pathological complete response. Methods: We retrospectively analyzed the clinicopathological parameters and pretreatment peripheral blood characteristics of breast cancer patients who received neoadjuvant chemotherapy between January 2018 and December 2023 and correlated these with the pathological findings after surgery. Data was collected from patients’ electronic health records. Patients with conditions that could act as confounding factors in the analysis of inflammatory markers, such as prior inflammatory diseases and pregnancy were excluded. Receiver Operating Characteristic (ROC) curves were used to determine the cutoff of NLR, LMR, PLR, ALC, SII, SIRI and BMI and the value with the highest Youden index was defined as the optimal cutoff. The chi-square test was used to explore the relationship between inflammatory markers with pCR and other clinicopathological parameters. Multivariate analyzes were performed using the logistic regression model. Results: A total of 263 patients were included during the period. The median age was 52 years; most patients were female (99.62%), with only one male patient (0.38%). Most tumors were hormone receptor–positive (67.79%) and HER2-negative (76.4%). Among the 267 tumors analyzed, 86 (32.21%) achieved pCR and this was significantly related to a higher ALC. Compared to patients with ALC ≤ 2985/mm 3 , patients with ALC > 2985/mm 3 had a 2.5 times greater chance of achieving pCR (odds ratio = 2.578; 95% CI: 1.146-5.798, p = 0.022). The other inflammatory markers were not significantly associated with pCR. Multivariate analysis indicated that a higher ALC, Ki67 > 20% and the HER-2 status were independent prognostic factors for pCR in breast cancer patients. Conclusions: Pretreatment ALC is predictive of pCR in patients with breast cancer receiving neoadjuvant chemotherapy and should be taken into consideration when discussing the treatment plan, as the index may aid in the formulation of personalized treatment strategies.