Prognostic value of the lymph node ratio for lymph-node-positive breast cancer- is it just a denominator problem?

Upali W Jayasinghe,Elisabeth Elder,Nirmala Pathmanathan,John Boyages

doi:10.1186/s40064-015-0865-2

Upali W Jayasinghe, Elisabeth Elder + Show 2 more

Open Access

https://doi.org/10.1186/s40064-015-0865-2

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Journal: SpringerPlus	Publication Date: Mar 11, 2015
Citations: 49	License type: CC BY 4.0

Affiliation: Westmead Institute, UNSW Sydney, Macquarie University

Abstract

PurposeTo examine the prognostic value of lymph node ratio (LNR) for patients with node-positive breast cancer with varying numbers of minimum nodes removed (>5, > 10 and > 15 total node count).MethodsThis study examined the original histopathological reports of 332 node-positive patients treated in the state of New South Wales (NSW), Australia between 1 April 1995 and 30 September 1995. The LNR was defined as the number of positive lymph nodes (LNs) over the total number of LNs removed. The LNR cutoffs were defined as low-risk, 0.01–0.20; intermediate-risk, 0.21– 0.65; and high-risk, LNR >0.65.ResultsThe median follow-up was 10.3 years. In multivariate analysis, LNR was an independent predictor of 10-year breast cancer specific survival when > 5 nodes were removed. However, LNR was not an independent predictor when > 15 nodes were removed. In a multivariate analysis the relative risk of death (RR) decreased from 2.20 to 1.05 for intermediate-risk LNR and from 3.07 to 2.64 for high-risk while P values increased from 0.027 to 0.957 for intermediate-risk LNR and 0.018 to 0.322 for high-risk with the number of nodes removed increasing from > 5 to > 15.ConclusionsAlthough LNR is important for patients with low node denominators, for patients with macroscopic nodal metastases in several nodes following an axillary dissection who have more than 15 nodes dissected, the oncologist can be satisfied that prognosis, selection of adjuvant chemotherapy and radiotherapy fields can be based on the numerator of the positive nodes.Electronic supplementary materialThe online version of this article (doi:10.1186/s40064-015-0865-2) contains supplementary material, which is available to authorized users.

Highlights

Axillary lymph node status is one of the most important prognostic factors for breast cancer (Schiffman et al 2011; Vinh-Hung et al 2003; Yiangou et al 1999)
More recently the Z00011 trial (Giuliano et al 2010; Giuliano et al 2011; Caudle et al 2011) was conducted to determine the effects of completion axillary lymph node dissection (ALND) on overall survival in patients with sentinel lymph node (SLN) metastases treated with breast conservation and adjuvant therapy including radiotherapy
We examined the prognostic value of lymph node ratio (LNR) for patients with node-positive breast cancer with varying numbers of minimum nodes removed (>5, > 10 and > 15 total node count)

Summary

Introduction

Axillary lymph node status is one of the most important prognostic factors for breast cancer (Schiffman et al 2011; Vinh-Hung et al 2003; Yiangou et al 1999). More recently the Z00011 trial (Giuliano et al 2010; Giuliano et al 2011; Caudle et al 2011) was conducted to determine the effects of completion axillary lymph node dissection (ALND) on overall survival in patients with sentinel lymph node (SLN) metastases treated with breast conservation and adjuvant therapy including radiotherapy. There is still debate about what constitutes an adequate axillary dissection in terms of the total number of lymph nodes removed. The number of involved lymph nodes is dependant on the total number of lymph nodes removed and examined, which in turn depends on surgical and pathologic procedures (Vinh-Hung et al 2009; Wang et al 2012). Some studies noted that six nodes were the minimum number of nodes needed to adequately assess

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