| Summary: | The neutrophil to lymphocyte ratio (NLR) is a promising predictive and prognostic factor in breast cancer. We investigated its ability to predict disease-free survival (DFS) and overall survival (OS) in patients with luminal A- or luminal B-HER2-negative breast cancer who received neoadjuvant chemotherapy (NACT). Pre-treatment complete blood cell counts from 168 consecutive patients with luminal breast cancer were evaluated to assess NLR. The study population was stratified into NLR<sup>low</sup> or NLR<sup>high</sup> according to a cut-off value established by receiving operator curve (ROC) analysis. Data on additional pre- and post-treatment clinical-pathological characteristics were also collected. Kaplan–Meier curves, log-rank tests, and Cox proportional hazards models were used for statistical analyses. Patients with pre-treatment NLR<sup>low</sup> showed a significantly shorter DFS (HR: 6.97, 95% CI: 1.65–10.55, <i>p</i> = 0.002) and OS (HR: 7.79, 95% CI: 1.25–15.07, <i>p</i> = 0.021) compared to those with NLR<sup>high</sup>. Non-ductal histology, luminal B subtype, and post-treatment Ki67 ≥ 14% were also associated with worse DFS (<i>p</i> = 0.016, <i>p</i> = 0.002, and <i>p</i> = 0.001, respectively). In a multivariate analysis, luminal B subtype, post-treatment Ki67 ≥ 14%, and NLR<sup>low</sup> remained independent prognostic factors for DFS, while only post-treatment Ki67 ≥ 14% and NLR<sup>low</sup> affected OS. The present study provides evidence that pre-treatment NLR<sup>low</sup> helps identify women at higher risk of recurrence and death among patients affected by luminal breast cancer treated with NACT.
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