Lymph node ratio as an alternative to pN staging for predicting prognosis after neoadjuvant chemotherapy in breast cancer

Abstract

Axillary nodal status is one of the most important prognostic factors in breast cancer. The lymph node ratio (LNR) has been suggested as an independent prognostic factor because the number of dissected and involved lymph nodes might differ across institutions. Neoadjuvant chemotherapy (NAC) has been the preferred treatment method for reducing tumor mass in the breast and axillary area. However, NAC can reduce total number of excised lymph nodes compared with upfront surgery. Therefore, an emerging question is whether axillary nodal status and LNR following NAC can accurately predict prognosis. We evaluated the prognostic value of axillary nodal status and LNR after NAC. A total of 236 patients were enrolled. Patients were divided into four groups according to the following cut-off values for LNR: 0 (n = 107), 0.01-0.20 (n = 68), 0.21-0.65 (n = 50) and >0.65 (n = 11). Pathologic complete responses were observed in 16.9% of the overall cohort. In univariate analysis, pathologic N stage was a significant prognostic factor of disease free survival (DFS, p = 0.013) and overall survival (OS, p = 0.004). However, in multivariate analysis, hormone receptor status (p = 0.043) and LNR (p = 0.028) were significantly associated with DFS and LNR (p = 0.017) showed statistical significance for OS; however, pathologic N stage was no longer significantly associated with DFS or OS. Traditional nodal staging has been accepted as an important prognostic factor; however, our result indicated that the nodal ratio could be an alternative to pN staging as a prognostic factor after NAC in breast cancer.

Lymph node ratio as best prognostic factor in triple‐negative breast cancer patients with residual disease after neoadjuvant chemotherapy

“…Studies in breast cancer patients have shown that LNR can be an independent prognostic factor for DFS and OS, in contrast to residual lymph node status according to ypN grading. 14,15 In the TNBC population, two studies identified better 5-year OS and DFS outcomes with the LNR as opposed to the yPN. 16,17 Previous research showed that the LNR is a good predictor of survival after NAC in nonspecific breast cancer; however, there is lack of information in patients with TNBC.…”

“…One of these parameters, the lymph node ratio (LNR), is defined as the ratio between positive nodes and resected nodes and has shown to be a promising predictor for the prognosis of survival after NAC. Studies in breast cancer patients have shown that LNR can be an independent prognostic factor for DFS and OS, in contrast to residual lymph node status according to ypN grading 14,15 . In the TNBC population, two studies identified better 5‐year OS and DFS outcomes with the LNR as opposed to the yPN 16,17 .…”

Factors Affecting Nodal Status in Breast Cancer

“…Any postoperative complications had been documented [e.g., seroma formation, wound infection and time to remove drain]. Surgical techniques had been performed as described by Chen et al [7] The collected data had been coded, fed to personal computer and statistically analyzed using a computer statistical package [ On the other side, table [2] presented the pre-and post-surgery factors that insignificantly associated with positive nodal status in 40 patients. These factors include estrogen receptor, progesterone receptor, tumor grade, and family history…”

“…Life expectancy had been also increased to reach 76 years in female and 70 years in males [1] . Nodal status is the most important prognostic factor for survival in BC patients [2] . Before the mid-1990s, axillary dissection was the standard method of staging of locoregional metastatic node, including patients with early BC.…”

Predictive Value of Lymph Node Ratio in Patients with Pancreatic Cancer Treated with Pancreatoduodenectomy

“…Although lymph node involvement is a common condition in most patients undergoing surgery (14,18), an increase in the number of metastatic lymph nodes can be a sign of poor survival (17). Ultimately, LNR evaluation has been suggested for predicting postoperative survival rate (19)(20)(21)(22)(23). There is no certainty about the value of this ratio and conflicting results have been reported (15,17).…”