Abstract
BackgroundThe aim of this study was to evaluate the prognostic value of the number of negative lymph nodes (NLNs) in breast cancer patients after mastectomy.Methods2,455 breast cancer patients who received a mastectomy between January 1998 and December 2007 were retrospectively reviewed. The prognostic impact of the number of NLNs with respect to disease-free survival (DFS) was analyzed.ResultsThe median follow-up time was 62.0 months, and the 5-year and 10-year DFS was 87.1% and 74.3%, respectively. The DFS of patients with >10 NLNs was significantly higher than that of patents with ≤10 NLNs, and the 5-year DFS rates were 87.5% and 69.5%, respectively (P < 0.001). Univariate Cox analysis showed that the NLN count (continuous variable) was a prognostic factor of DFS (hazard ratio [HR] = 0.913, 95% confidence interval [CI]: 0.896-0.930, P < 0.001). In multivariate Cox analysis, patients with a higher number of NLNs had a better DFS (HR = 0.977, 95% CI: 0.958-0.997, P = 0.022). Subgroup analysis showed that the NLN count had a prognostic value in patients at different pT stages and pN positive patients (log-rank P < 0.001). However, it had no prognostic value in pN0 patients (log-rank P = 0.684).ConclusionsThe number of NLNs is an independent prognostic factor of DFS in breast cancer patients after mastectomy, and patients with a higher number of NLNs have a better DFS.
Highlights
The aim of this study was to evaluate the prognostic value of the number of negative lymph nodes (NLNs) in breast cancer patients after mastectomy
human epithelial growth factor receptor family 2 (Her2)-positivity was defined as a 3+ immunohistochemical result or a 2+ immunohistochemical result confirmed by fluorescent in situ hybridization (FISH). pT stage and pN stage were consistent with the UICC/AJCC TNM classification (7th Edition), and pN stages were defined as follows: pN0, no regional lymph node metastasis identified histologically; pN1, metastasis in 1–3 lymph nodes; pN2, metastasis in 4–9 lymph nodes; pN3, metastasis in ≥10 lymph nodes
In the present study, we investigated the impact of the number of NLNs removed after mastectomy in breast cancer patients and found that the number of NLNs removed was an independent prognostic factor of disease-free survival (DFS)
Summary
The aim of this study was to evaluate the prognostic value of the number of negative lymph nodes (NLNs) in breast cancer patients after mastectomy. Though the survival rates of patients receiving sentinel lymph node biopsy and of patients receiving axillary lymph node dissection are similar in a certain specific populations with breast cancer [1,2], and sentinel lymph node biopsy can decrease postoperative arm lymphedema [3,4], the axillary lymph node status is still one of the most important prognostic indicators of breast cancer patients and is useful for guiding treatment. It is important in the Union for International Cancer Control/American Joint Committee on Cancer (UICC/AJCC) tumor, node, metastasis (TNM) staging system for breast cancer. Because both positive and negative lymph nodes are removed, it is difficult to accurately determine the proper number of lymph nodes that should be removed
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