Impact of number of positive lymph nodes and lymph node ratio on survival of women with node-positive breast cancer

Abstract

This study aimed to evaluate the association of axillary lymph node ratio (LNR) and number of positive lymph nodes (pN) with the risk of breast cancer recurrence and death. Methods: A retrospective cohort study of node-positive stage II e III breast cancer patients diagnosed and treated between 2008 and 2009 at the Brazilian National Cancer Institute (INCA), Brazil. Overall and disease-free survival curves for number of positive lymph nodes (pN) and lymph node ratio (LNR) risk groups were constructed using the Kaplan-Meier method and compared by the log-rank test. Multivariate analysis was performed using stepwise forward Cox regression models. Results: In total, 628 women with node-positive breast cancer were included. Most patients (69.5%) had advanced clinical stage tumors (≥ IIB). The median follow-up was 58 months (range: 3-92 months). The adjusted recurrence hazard of pN2 and pN3 patients was 2.47 (95% Confidence Interval [CI] 1.72-3.56) and 2.42 (1.62-3.60), respectively, compared to pN1 patients (p<0.001), while the hazard of intermediate (0.21-0.65) and high-risk (>0.65) LNR was 2.11 (1.49-3.00) and 3.19 (2.12-4.80), respectively, compared to low-risk LNR (≤0.20) patients (p<0.001). On the other hand, the hazard of death of pN2 and pN3 patients was 2.17 (1.42-3.30) and 2.41 (1.53-3.78), respectively (p<0.001), and the hazard of intermediate (0.21-0.65) and high-risk (>0.65) LNR patients was 1.70 (1.13-2.56) and 2.74 (1.75-4.28), respectively (p≤0.001). Conclusion: Higher pN and LNR were associated with shorter disease-free survival and overall survival times.

Impact of axillary node-positivity and surgical resection margins on survival of women treated for breast cancer in Ibadan, Nigeria

“…Late stage at presentation has been associated with increased risk of mortality, especially in Low- and middle-income countries where social factors play a pivotal role in timing of presentation as well as acceptance of orthodox treatment, including breast-conserving surgery and mastectomy [ 6 – 8 ]. While surgical extirpation continues to be the mainstay of loco-regional disease control by achieving negative margins and lymph node clearance, it is well documented that the nodal status at diagnosis significantly affects overall survival, with axillary lymph nodal metastasis being a critical index of prognostication [ 9 – 11 ]. Furthermore, lymph node ratio (LNR), defined as the proportion of harvested lymph nodes positive for malignancy to total resected nodes [ 12 , 13 ], has been implicated as a key prognostic factor.…”

“…Furthermore, lymph node ratio (LNR), defined as the proportion of harvested lymph nodes positive for malignancy to total resected nodes [ 12 , 13 ], has been implicated as a key prognostic factor. High LNR has not only been associated with unfavourable survival outcomes, its prognostic effect is found to be superior to total number of nodes [ 11 ]. Although the goal of surgery in breast cancer is to extirpate both macroscopic and microscopic tumour presence, the presence of a positive resection margin necessitates adjuvant radiotherapy with or without chemotherapy [ 14 – 16 ].…”

“…It is hoped that the utilisation of such multimodal approach to breast cancer care would keep the 5-year survival rate in sub-Saharan Africa on the upward trend [ 18 – 20 ]. Therefore, an intensive multimodal approach to breast cancer care is key to achieving longer disease-free survival and overall survival times [ 10 , 11 ].…”

Association of axillary node status with clinicopathological characteristics and expression of EZH2 and CD44 in primary breast ductal carcinoma

“…Patients with four or more positive lymph nodes have a worse prognosis compared to those having three or fewer histologically positive lymph nodes. 21 This study identified that higher pN was associated with some parameters which influenced ALN involvement, i.e. with high EZH2, high EZH2 with negative ER status, advanced clinical stage and advanced tumors stage (p=0.006; 0.001; p=0.002; 0.001).…”

The Adventure of Axillary Treatment in Early Stage Breast Cancer

“…Axillary lymph node dissection (ALND) was an essential part of breast cancer treatment and erstwhile for a lengthy period was the sole gold standard in evaluation of the status of axillary lymph node. The benefits of ALND were staging the axilla, providing important prognostic information, improving of axillary regional control, and the probable improvement of survival and disease-free survival (DFS) (1)(2)(3). As to the harms of ALND; they are known as increased arm oedema, restrictions in the arm movements, and reduction of quality of life.…”