<p>This study focuses on comparing the difference in efficacy of neoadjuvant chemotherapy (NAC) albumin paclitaxel combined with carboplatin regimen (TCb) versus conventional chemotherapy (TAC and EC-T) regimens for the treatment of stage II and III triple-negative breast cancer (TNBC). To analyze the relationship between NPAR levels, degree of neutropenia, and clinicopathological features and pathological complete response (pCR) and to determine the independent influences on pCR.A clinical subject operating characteristic curve (ROC) was used to determine independent predictors of pCR. Clinical data of TNBC patients who attended the department of thyroid and breast surgery of the Affiliated People’s Hospital of Shandong First Medical University and underwent NAC from June 2021 to February 2025 were retrospectively analyzed. Based on the inclusion and exclusion criteria, 150 patients were finally enrolled. According to the differences in NAC regimens, they were categorized into TCb group (n=50), docetaxel + doxorubicin + cyclophosphamide (TAC group, n=60), and epirubicin combined with cyclophosphamide followed by docetaxel (EC-T group, n=40). Differences in pCR rate, ORR rate, incidence of adverse events, and tumor marker levels were compared among the three groups. Clinical value of using ROC curves to assess the clinical value of assessing the neutrophil-to-albumin ratio (NPAR) levels, myelosuppression (degree of neutropenia), Ki-67 expression, and lymph node staging to predict pCR, determine the optimal NPAR cutoff value based on the maximum Yoden index.Binary logistic regression was used to analyze the independent influences of pCR, differences in performance in comparing multiple ROC curves for predicting pCR. After NAC, there was no statistically significant difference in pCR rate and ORR rate among the three groups (<i>P</i> &gt; 0.05); there was no statistically significant difference in the incidence of adverse reactions to chemotherapy among the three groups of patients (<i>P</i>&gt;0.05) . After NAC, there was no statistically significant difference between the three groups in CA153 (<i>P&gt;</i>0.05) ; nonparametric rank-sum test analysis revealed that, after NAC, the differences between the three groups were statistically significant in CEA and CA125 (<i>P</i>&lt;0.05) ; further LSD test was performed and the levels of CEA and CA125 in the TCb group were smaller than those in the TAC and EC-T groups. (<i>P</i>&lt;0.05) ; There was no statistically significant difference between the TAC and EC-T groups in CEA and CA125 (<i>P&gt;</i>0.05) . Based on the analysis of the results of the ROC, the optimal cutoff value of NPAR was 18.5, the maximum Yoden index was 0.594, the sensitivity was 0.765, the specificity was 0.829, AUC = 0.845, 95% CI 0.783-0.908 (<i>P</i>&lt;0.05) . Lymph node staging, Ki-67 expression, myelosuppression and NPAR levels are independent influences on pCR (<i>P</i>&lt;0.05) ; TNBC with lymph node stage I, high Ki-67 expression, severe neutropenia, and high levels of NPAR were more likely to achieve pCR. Based on the analysis of the results of the ROC curve, the better performance in predicting pCR after combining multiple metrics (AUC=0.946, <i>P</i>&lt;0.05) , which was superior to NPAR (AUC=0.845), Ki-67 (AUC=0.774), myelosuppression (AUC=0.7205) and lymph node staging (AUC=0.609); In addition, on a single indicator, NPAR levels, degree of neutropenia, and Ki-67 expression predicted pCR with better performance (all AUC&gt;0.70). Neoadjuvant TCb is a preferred treatment option for TNBC, which is better tolerated by patients and has manageable adverse effects. TNBC patients with high levels of NPAR, severe neutropenia, high Ki-67 expression, and lymph node stage I are more likely to achieve pCR. In addition, NPAR, Ki-67 expression and severe neutropenia were all good predictors of pCR, the better performance in predicting pCR after combining multiple metrics.</p>