Abstract
To evaluate the relationships between lymph node ratio (LNR, the ratio of positive lymph nodes in excised axillary lymph nodes) and disease-free survival (DFS) by comparing with traditional absolute positive lymph node number (pN classification) for prediction of breast cancer (BC) progrnosis. We retrospectively reviewed patients who received comprehensive therapy in Department of Breast Surgery, Hubei Cancer Hospital, China from Jan 2002 to Dec 2006 (Group A), and Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, China from Jun 2008 to May 2012 (Group B). Patients were allocated to low-risk (≤0.20), intermediate-risk (> 0.20 but ≤ 0.65), high-risk (>0.65) groups by LNR. The primary endpoint was 5-DFS. A total of 294 patients were included in our study. LNR was verified as a negative prognostic factor for DFS (P= 0.002 in Group A, P< 0.0001 in Group B). Then we found the effects of pN and LNR delamination on disease-free survival (DFS) had statistical significance (P=0.012 for pN and P=0.031 for LNR stratification in Group A, both of them P<0.001 in Group B). Compared to pN staging, LNR staging displayed superior performance in prognosis, the adjusted hazard ratio of recurrence being 2.07 (95%CI, 1.07 to 4.0) for intermediate risk group (P=0.030) and 2.44 (95%CI, 1.21 to 4.92) for high risk group (P=0.013) in Group A. LNR stratification proved an adverse prognostic factor of DFS in lymph nodes positive invasive BC using cut-off values 0.20 and 0.65, and was more predictive than traditional pN classification for 5-DFS.
Highlights
Over the past three decades, the breast cancer (BC) incidence has been steadily increasing and becoming the most common malignancy in large cities, like Shanghai (Fan et al, 2009) in China
Two hundred and ninety four BC patients with lymph nodes positive were selected and 93 patients were developed recurrences with 29 (16.3%) patients of Group B at the media follow up 28 months (6 to 60 months) and 64 (55.2%) of Group A at the media follow up 41 months (2 to 60 months)
Accurate evaluation is fundamental for BC personalized treatment and lymph nodes status was the most important prognostic factor
Summary
Over the past three decades, the breast cancer (BC) incidence has been steadily increasing and becoming the most common malignancy in large cities, like Shanghai (Fan et al, 2009) in China. The BC patients could be divided into four grades (N0-N3) by absolute positive numbers of lymph nodes metastasis (traditional lymph nodes classification, pN classification) according to the International Union Against Cancer (UICC)/American Joint Committee on Cancer (AJCC) guideline, resulting different treatment and clinical outcome for BC patients. This stratification was simple and intelligible, making it widely used in clinical practice. In clinical practice, this process could be limited by many factors, such as surgical procedures, pathological identification, individual variances, and so on, resulting a wide range (1 to 57) of total number of lymph nodes identification among BC patients and institutions (Voordeckers et al, 2004; Truong et al, 2005; Danko et al, 2010)
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