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Objective: To explore the relationship between the neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), lymphocyte to monocyte ratio (LMR) in peripheral blood before chemotherapy and the efficacy and prognosis of neoadjuvant chemotherapy of patients with breast cancer. Methods: The 105 patients with breast cancer who were underwent surgery after neoadjuvant chemotherapy in Anqing First People's Hospital affiliated to Anhui Medical University from October 2016 to January 2018 were selected as the study subjects, and they were divided into pathological complete remission (pCR) group (26 cases) and non pCR group (79 cases) according to the efficacy of neoadjuvant chemotherapy. The NLR, PLR and LMR in peripheral blood before chemotherapy of pCR group and non pCR group were compared. The predictive value of NLR, PLR and LMR in peripheral blood before chemotherapy of patients with breast cancer for the pathological effect of neoadjuvant chemotherapy was analyzed by receiver operating characteristic (ROC) curve. All patients were followed up for 5 years after surgery, and divided into high NLR, PLR, LMR groups and low NLR, PLR, LMR groups based on the optimal cutoff values of NLR, PLR, and LMR determined by the ROC curve. The 5-year disease-free survival(DFS) time of NLR, PLR, and LMR groups at different levels were analyzed by K-M survival curve. Single factor and multivariate COX regression analysis of factors affecting poor prognosis. Results: The NLR and PLR before chemotherapy in the pCR group were lower than those in the non pCR group (P<0.05), while the LMR was higher than that in the non pCR group (P<0.05). The area under the curve (AUC) of the combined prediction of NLR, PLR, and LMR for the pathological efficacy of neoadjuvant chemotherapy before chemotherapy was greater than that predicted by each index alone. K-M survival curve analysis showed that the 5-year DFS of the high NLR and PLR groups before chemotherapy was lower than that of the low NLR and PLR groups (P<0.05), and the 5-year DFS of the high LMR group was higher than that of the low LMR group (P<0.05). Single factor and multivariate COX regression analysis showed that elevated the NLR and PLR were risk factors for the prognosis of breast cancer, and elevated LMR were protective factor(P<0.05). Conclusion: The pCR group had lower NLR and PLR before chemotherapy, higher LMR, and lower 5-year DFS in patients with high NLR, PLR, and low LMR. NLR, PLR and LMR have certain predictive value for the pathological effect of neoadjuvant chemotherapy, and the combination of the three can provide important reference for the evaluation of neoadjuvant chemotherapy for breast cancer. [ABSTRACT FROM AUTHOR]