Prognostic significance of total number of nodes removed, negative nodes removed, and ratio of positive nodes to removed nodes in node positive breast carcinoma

Abstract

Background This study was undertaken to investigate whether total number of nodes (pNtot) removed, negative nodes removed (pNneg), and ratio of positive nodes to total nodes removed (pNratio) are predictors of survival in node positive patients. Study design The records of 801 consecutive invasive breast cancer patients with T1-3 tumour and positive axillary lymph node who underwent modified radical mastectomy in our hospital were reviewed. pNtot and pNneg were categorized, and pNratio was computed. The influence of these probable prognostic factors on survival was investigated. Survival curves were generated by Kaplan–Meier method and log-rank test was used for comparisons. Multivariate analyses were performed by Cox proportional hazard model. Results Median pNtot, and pNneg are 19 (range 5–54), and 13 (range 0–53), respectively. pNtot > 15, and pNneg > 15 were independently associated with reduced hazard ratios (HRs) of 0.62 (CI 0.48–0.79), and 0.68 (CI 0.52–0.89), respectively. The highest ratio (>0.25) of pNratio is associated with the highest hazard ratio for death (HR 3.8, CI 2.74–5.50) compared to the lowest ratio for death (<0.001). Conclusions pNtot, pNneg, and pNratio appear prognostic factors for survival in node positive breast cancers. Axillary lymph node dissection with more number of nodes removed (>15) or negative nodes (>15) are associated with increased survival.