A nomogram based on the lymphocyte-to-monocyte ratio and changes in tumor blood supply and volume for predicting pathological complete response of triple negative breast cancer after neoadjuvant chemotherapy

Background Early and accurate prediction of the response to neoadjuvant chemotherapy (NACT) in triple negative breast cancer (TNBC) patients holds significant clinical value. This study investigated the role of the lymphocyte-to-monocyte ratio (LMR), changes in tumor blood supply and volume after two cycles of NACT, and their association with pathological complete response (pCR) in TNBC patients, aiming to establish and validate a nomogram for predicting pCR. Methods From January 2018 to May 2025, 379 TNBC patients were enrolled. The correlation between pCR and peripheral blood inflammatory markers, clinicopathological factors, and tumor ultrasound (US) features was analyzed using the chi-square test. Logistic regression analysis was performed to identify factors potentially influencing pCR. Based on the logistic regression analysis results, a nomogram was developed and validated to predict pCR. Results 42.74% (162/379) of TNBC patients achieved pCR after NACT. Logistic regression analysis identified Ki67 (OR: 4.228, 95% CI: 2.600–7.073, P < 0.0001), tumor volume reduction after two NACT cycles (OR: 3.052, 95% CI: 1.752–5.318, P < 0.0001), lymphocyte-to-monocyte ratio (LMR) (OR: 1.762, 95% CI: 1.076–2.884, P = 0.024), and decreased tumor blood supply after two NACT cycles (OR: 0.199, 95% CI: 0.122–0.324, P < 0.0001) as independent predictors of pCR after NACT. A nomogram prediction model was developed based on these positive indicators, demonstrating good predictive ability. Conclusion This predictive model will assist in early prediction of pCR after NACT in TNBC patients, helping clinicians optimize treatment regimens. Trial registration Not applicable.