Prognostic value of the lymph node ratio in breast cancer subtypes

Liao, Guo‐Shiou; Chou, Yu‐Ching; Golshan, Mehra; Hsu, Huan-Ming; Hong, Zhi-Jie; Yu, Jyh‐Cherng; Zhu, Jihong

doi:10.1016/j.amjsurg.2014.12.054

Cited by 21 publications

(22 citation statements)

References 26 publications

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“…Maximum total cases in MLR3 group were poorly differentiated. Table-3: Distribution of cases as per the tumor grade PRIMARY ORGAN WD MD PD TOTAL HN 10 1 1 12 BREAST 0 15 18 33 GIT 3 6 2 11 GUT 1 0 1 2 TOTAL 14 22 22 58 We evaluated the relation of MLR with tumor stage and tumor grade 5]. There was significant association between MLR with tumor stage and tumor grade (p-value < 0.001).…”

Section: Resultsmentioning

confidence: 99%

“…A study done by Chen et al on HN case reported that patient with higher MLR was shown to have poor survival. [4] LNR and number of positive lymph nodes are important prognostic factors with regard to overall survival for patients with nodepositive breast cancer, but LNR has a more correlated value in breast cancer subtypes [5]. Lee et al in his published study declared that the MLR was a simple and reproducible prognostic factor that supplemented the limitation of the conventional N staging system and provided more accurate prognostic stratification in advanced gastric cancer [12].…”

Section: Discussionmentioning

confidence: 99%

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Metastatic Lymph Node Ratio: A Promising Parameter and Its Relation with Patient Related Factors in Cases of Primary Organ Malignancy

Rajeshbhai¹,

Prakashbhai²

2019

SJPM

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Background: Metastatic lymph node ratio (MLR) is defined as the ratio of number of positive lymph nodes (LNs) or LNM to total nodes harvested (LNH). Recent studies have suggested that MLR is more accurate in predicting overall survival and recurrence-free survival rate compared to the number of positive nodes alone. Materials and methods: Total 58 cases of primary organ malignancy were evaluated from June 2018 to June 2019 including Head and neck (HN), Breast, Gastrointestinal tract (GIT) and Genitourinary tract (GUT) malignancy. Age, gender, LNH, LNM, MLR, tumor stage and tumor grade were accessed for each of the cases. Results: Out of total 58, there were 12, 33, 11 and 2 cases each of HN, Breast, GIT and GUT malignancy respectively. M:F ratio was 1:2.2. Maximum cases (39.6%) were seen in the age group of 35-45 years. 186 out of 530 LNs showed metastasis. Mean MLR for lymph node-positive cases were 0.3. Majority of HN malignancy cases (41.6%) were found in T1/T2 stage, breast malignancy cases (42.4%) in T2 stage, GIT malignancy cases (63.6%) in T3 stage, 50% of GUT malignancy cases in T3 and 50% were in T4 stage. Maximum well-differentiated (10, 83.3%) cases belonged to HN, moderately (15, 45.4%) and poorly differentiated (18, 54.5%) to breast respectively. We found significant association of MLR with tumor stage and tumor grade. (p-value < 0.001) Conclusion: The routine inclusion of MLR in tumor reporting by pathologists may become a prognostic aid for clinicians along with TNM staging system.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Metastatic Lymph Node Ratio: A Promising Parameter and Its Relation with Patient Related Factors in Cases of Primary Organ Malignancy

Rajeshbhai¹,

Prakashbhai²

2019

SJPM

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“…In FIGO stage I, a large number of resected lymph nodes did not represent a better outcome. The patients with [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] RLNs have the best prognosis. When RLNs numbered more than 30, the survival rate decreased.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, increasing attention has been paid to lymph node status, which can be evaluated by the number of resected lymph nodes (RLNs), 15 lymph node ratio (LNR), [16][17][18] and the log odds of positive lymph nodes (LODDS). [19][20][21][22][23][24] Compared to a single parameter, LNR exhibits its advantage in breast, [25][26][27][28] pancreatic, 19 colon, [29][30][31][32] and ovarian 16,18 cancers. Another parameter, LODDS, showed superiority in predicting outcomes in breast, 20 pancreatic, 19,21 colorectal, 22,23 and ovarian 24 cancers.…”

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confidence: 99%

Survival effect of different lymph node staging methods on ovarian cancer: An analysis of 10 878 patients

Wang

Chen

et al. 2018

Cancer Medicine

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BackgroundTo compare the survival impact of several lymph node staging methods and therapeutic role of lymphadenectomy in patients with epithelial ovarian cancer who had undergone lymphadenectomy.MethodsData were retrospectively collected from the Surveillance, Epidemiology, and End Results program between 1988 and 2013.ResultsAn increasing number of resected lymph nodes (RLNs) was associated with a significant improvement in survival of FIGO stage II and III disease. However, for FIGO stage IV patients, better survival was not significantly associated with a more extensive lymphadenectomy. A higher lymph node ratio (LNR) and log odds of positive lymph nodes (LODDS) were associated with poorer survival regardless of stage. Nevertheless, four‐category classification of LODDS was more suitable for stage IV patients when three‐category classification was compatible with stage I‐III disease. Multivariate analysis demonstrated that LODDS and LNR were significant independent prognostic factors, but not RLN classification.ConclusionSixteen to thirty RLNs are recommended for stage I disease. For stages II and III patients, the more lymph node excision, the better the prognosis. However, lymphadenectomy was nonessential for stage IV patients. Considering staging methods, for stages II and III patients, three‐category classification of LODDS was recommended to evaluate the prognosis. For stage I and IV, three‐category classification of positive LNR was idoneous.

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“…It has been confirmed as a highly reliable indicator used to evaluate the prognosis of various malignant solid tumors, such as lung, breast, gastric, colon, gallbladder, and ovarian cancer89101112. Although the advantage of LNR over the AJCC N category in predicting the prognosis of patients with EC has been extensively explored, this parameter has yet to be integrated into the current staging system13.…”

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confidence: 99%

Metastatic lymph node ratio demonstrates better prognostic stratification than pN staging in patients with esophageal squamous cell carcinoma after esophagectomy

Zhang

Liang

Gao

et al. 2016

Sci Rep

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This study aimed to evaluate the prognostic significance of lymph node ratio (LNR) by establishing a hypothetical tumor-ratio-metastasis (TRM) staging system in patients with esophageal squamous cell carcinoma (ESCC). The records of 387 ESCC patients receiving curative esophagectomy were retrospectively investigated. The optimal cut-point for LNR was assessed via the best cut-off approach. Potential prognostic parameters were identified through univariate and multivariate analyses. A novel LNR-based TRM stage was proposed. The prognostic discriminatory ability and prediction accuracy of each system were determined using hazard ratio (HR), Akaike information criterion (AIC), concordance index (C-index), and area under the receiver operating characteristic curve (AUC). The optimal cut-points of LNR were set at 0, 0~0.2, 0.2~0.4, and 0.4~1.0. Multivariate Cox analysis indicated that the LNR category was an independent risk factor of overall survival (P < 0.001). The calibration curves for the probability of 3- and 5-year survival showed good consistency between nomogram prediction and actual observation. The LNR category and TRM stage yielded a larger HR, a smaller AIC, a larger C-index, and a larger AUC than the N category and TNM stage did. In summary, the proposed LNR category was superior to the conventional N category in predicting the prognosis of ESCC patients.

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Prognostic value of the lymph node ratio in breast cancer subtypes

Cited by 21 publications

References 26 publications

Metastatic Lymph Node Ratio: A Promising Parameter and Its Relation with Patient Related Factors in Cases of Primary Organ Malignancy

Metastatic Lymph Node Ratio: A Promising Parameter and Its Relation with Patient Related Factors in Cases of Primary Organ Malignancy

Survival effect of different lymph node staging methods on ovarian cancer: An analysis of 10 878 patients

Metastatic lymph node ratio demonstrates better prognostic stratification than pN staging in patients with esophageal squamous cell carcinoma after esophagectomy

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