The value of LAR in predicting neoadjuvant therapy response and prognosis in HER2-positive breast cancer

In the personalized treatment of HER2-positive breast cancer, identifying biomarkers predictive of neoadjuvant therapy (NAT) response and long-term prognosis is crucial. This study investigates the association between the lactate dehydrogenase-to-albumin ratio (LAR) and both NAT efficacy and survival outcomes, while examining clinical-pathological factors influencing LAR.

This retrospective study analyzed clinical and pathological data from 302 HER2-positive breast cancer patients who underwent NAT followed by surgical resection. Patients were stratified into two groups based on median pre-NAT LAR levels. Logistic regression identified independent predictors of NAT response. Kaplan-Meier survival analysis and Cox proportional hazards regression evaluated correlations between LAR and disease-free survival (DFS) or overall survival (OS). Univariate and multivariate analyses determined clinical and pathological factors influencing LAR.

Logistic regression analysis identified LAR levels, hormone receptor status, and pre-NAT tumor size as independent predictors of NAT response. Patients in the high-LAR group exhibited a higher probability of achieving pathological complete response (pCR) following neoadjuvant therapy. Cox regression and Kaplan-Meier analyses demonstrated significantly shorter disease-free survival (DFS) in the high-LAR cohort compared to the low-LAR group. Furthermore, among patients who experienced disease progression, high pre-NAT LAR was significantly associated with early recurrence (≤ 24 months) (P = 0.005). Crucially, subgroup and interaction analyses revealed that the predictive and prognostic value of LAR was more pronounced in the hormone receptor (HR)-negative subgroup (P for interaction = 0.043). Among clinical and pathological factors, LAR levels correlated significantly with hormone receptor-negative status and postmenopausal condition.

In HER2-positive breast cancer, elevated pre-NAT LAR serves as an independent predictor for pCR after NAT, while concurrently constituting an independent risk factor for reduced DFS. This dual effect is particularly pronounced in HR-negative patients. Furthermore, HR-negative status and postmenopausal condition were significantly associated with higher LAR levels, highlighting LAR as a potential indicator of a hostile host systemic environment.