To Study the Neutrophil–Lymphocyte Ratio as a Predictive Marker of Response to Neoadjuvant Chemotherapy in Locally Advanced Triple-Negative Breast Cancer

Aims and Objectives: Inflammation is key driver of cancer development and progression. Neutrophil is an important component of tumor induced inflammatory response whereas lymphocyte is related to antitumor immune response. The neutrophil–lymphocyte ratio (NLR) is a cost-effective and simple inflammatory parameter. The present study is designed to explore the predictive value of NLR for predicting pathological complete response (pCR) after NACT in locally advanced TNBC. Materials and Methods: Total of 120 patients with locally advanced TNBC planned for NACT and subsequent breast surgery are recruited for this prospective observational study. All clinicopathological characteristics noted and a baseline peripheral complete blood count is performed. NLR calculated as the ratio between absolute neutrophil and lymphocyte counts. ROC curve is used to predict the relationship between pCR and NLR. Correlations between clinicopathologic variables, NLR and the response to NACT will be assessed using the chi-square test. A binary logistic regression model will be used for prediction. Results: A total 101 patients were included for the final analysis after excluding 19 patients (16 defaulters and 3 progressive disease). pCR was seen in 30.7% (31/101) patients. Optimal NLR cutoff value of 2.185 was identified and was associated with sensitivity of 67.7% and specificity of 67.1%. Mean NLR ratio in patients with pCR was 2.29 ± 1.21. We found that higher NLR were significantly associated with non-pCR. Area under the curve for the resultant predictive scoring model was 0.672 (95% CI: 0.554–0.791). Conclusion: Our study underscores the utility of NLR as a non-invasive biomarker for predicting treatment response in triple negative LABC patients undergoing NACT. Lower baseline NLR are more likely to exhibit pCR. Publication History Article published online: 20 February 2026 © 2026. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/) Thieme Medical and Scientific Publishers Pvt. Ltd. A-12, 2nd Floor, Sector 2, Noida-201301 UP, India