The Value of LAR in Predicting Neoadjuvant Therapy Response and Prognosis in HER-2-Positive Breast Cancer

Background: In the personalized treatment of HER-2-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. Materials and Methods: This retrospective study analyzed clinical and pathological data from 302 HER-2-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. Results: 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. Among clinical and pathological factors, LAR levels correlated significantly with hormone receptor positivity and menopausal status. Conclusion: In HER-2-positive breast cancer, elevated pre-operative LAR serves as an independent predictor for pCR after NAT, while concurrently constituting an independent risk factor for reduced postoperative DFS. Furthermore, hormone receptor-positive status and postmenopausal condition were significantly associated with higher LAR levels.