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Predictive factors for response to neoadjuvant chemotherapy: inflammatory and immune markers in triple-negative breast cancer

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Abstract

Background

Tumor-infiltrating lymphocytes (TILs) predict response to neoadjuvant chemotherapy (NAC) in triple-negative breast cancer (TNBC) patients. However, the TIL level can be determined at a few facilities. By contrast, neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are easily and objectively determined from the results of full blood counts. We conducted a retrospective study to investigate whether TILs, NLR, and PLR predict NAC efficacy and whether NLR and PLR could be surrogate markers for TILs in TNBC.

Methods

Of the 266 patients diagnosed with TNBC between 2013 and 2019, 66 who underwent radical surgery after sequential administration of anthracycline and taxane as NAC were included in the study. TILs, NLR, and PLR were evaluated as predictors of pathologic complete response (pCR) using cutoff values determined from receiver operating characteristic curves.

Results

The cutoff values of TILs, NLR, and PLR were 20%, 2.6, and 180, respectively. High TIL level was associated with low NLR (P = 0.01) and low PLR (P = 0.01). High TIL level (odds ratio [OR] 4.28 [95% CI 1.40–13.1]; P = 0.01), low NLR (OR 5.51 [95% CI 1.60–18.9]; P = 0.01), and low PLR (OR 3.29 [95% CI 1.13–9.57]; P = 0.03) were associated with pCR. Low NLR predicted pCR independently (OR 6.59 [95% CI 1.45–30.0]; P = 0.01).

Conclusions

TILs, NLR, and PLR predicted NAC efficacy against TNBC. TIL level was associated with NLR and PLR. NLR was an independent predictive factor and may be a useful surrogate marker for TILs when predicting pCR.

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Data availability

Data available on request due to privacy/ethical restrictions.

Change history

  • 15 October 2023

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Authors and Affiliations

  1. Department of Breast and Endocrine Surgery, Osaka International Cancer Institute, 3-1-69 Otemae Chuo-Ku, Osaka, 541-8567, Japan

    Hiroki Kusama, Ai Soma, Azusa Taniguchi, Haruka Kanaoka, Satomi Nakajima, Yuri Oyama, Yukiko Seto, Jun Okuno, Noriyuki Watanabe, Saki Matsui & Takahiro Nakayama

  2. Department of Breast Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-Cho Kita-Ku Sakai-Shi, Osaka, 541-8567, Japan

    Nobuyoshi Kittaka

  3. Department of Medical Oncology, Osaka International Cancer Institute, Osaka, Japan

    Minako Nishio & Fumie Fujisawa

  4. Department of Pathology, Osaka International Cancer Institute, Osaka, Japan

    Keiichiro Honma

  5. Department of Breast and Endocrine Surgery, Kaizuka City Hospital, 3-10-20 Hori Kaizuka-Shi, Osaka, 597-0015, Japan

    Yasuhiro Tamaki

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  1. Hiroki Kusama
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Contributions

HK: conceptualization, data curation, formal analysis, investigation, methodology, visualization, and writing––original draft preparation. NK: editing, visualization, resources, and writing––review and editing. AS: resources. AT: resources. HK: resources. SN: resources. YO: resources. YS: resources. JO: resources. NW: resources. SM: resources. MN: resources. FF: resources. KH: methodology and resources. YT: resources. TN: project administration, resources, visualization, and writing––review and editing. All authors critically reviewed and approved the final manuscript.

Corresponding author

Correspondence to Takahiro Nakayama.

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Conflict of interest

Takahiro Nakayama received honoraria (lecture fees) unrelated to this work from Eli Lilly, Pfizer, Daiichi Sankyo, Eisai, AstraZeneca, Chugai Pharmaceutical, Sandoz, Novartis, and MSD. The other authors declare no conflict of interest.

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Kusama, H., Kittaka, N., Soma, A. et al. Predictive factors for response to neoadjuvant chemotherapy: inflammatory and immune markers in triple-negative breast cancer. Breast Cancer 30, 1085–1093 (2023). https://doi.org/10.1007/s12282-023-01504-y

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