Prognostically Distinctive Subgroup in Pathologic N3 Breast Cancer

Abstract

PurposeThe aim of this retrospective study was to investigate whether there are prognostically different subgroups among patients with pathologic N3 (pN3) breast cancer.MethodsThe records of 220 patients who underwent surgery for pN3 breast cancer from January 2006 to September 2012 were reviewed. All patients received adjuvant therapy according to standard protocols. The primary outcome was disease-free survival (DFS).ResultsPatients were followed for a median time of 68.3 months after their primary surgery (range, 10–122 months), during which time 75 patients (34.1%) had developed disease recurrence and 48 patients (21.8%) had died. The DFS and overall survival were 67.8% and 86.1%, respectively, at 5 years. Multiple logistic regression analysis showed that young age (<35 years, p=0.009), high serum neutrophil/lymphocyte ratio (>3.0) (p=0.020), high nodal ratio (number of metastatic lymph nodes divided by number of removed nodes) (>0.65) (p=0.062), and molecular phenotype (p=0.012) were significantly associated with tumor recurrence. Tumor biological subtype was the most significant predictor of recurrence. The 5-year DFS rates in patients with hormone receptor (HR) positive and human epidermal growth factor receptor 2 (HER2) negative, HR+HER2+, HR–HER2+, and triple negative subtypes were 82%, 63%, 58%, and 37%, respectively.ConclusionClinical outcomes of patients with extensive nodal metastasis were heterogeneous in terms of prognosis. Tumor biological subtype was the most important prognostic factor for pN3 disease. The prognosis of patients with HR+HER2– subtype in pN3 breast cancer was similar to that of patients with stage II breast cancer.

Neutrophil to Lymphocyte Ratio as Prognostic and Predictive Factor in Breast Cancer Patients: A Systematic Review

“…(2) Patients Receiving Adjuvant Treatment Twenty-three studies reported data on NLR as a prognostic factor in patients with localized BC receiving adjuvant treatment . Most studies (n = 18; 78%) included patients with all BC molecular subtypes [32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48]. four included only patients withTNBC [49][50][51][52], and one work included patients with onlyhormone receptor-negative BC (independently of the HER2 status) [53].…”

“…The number of enrolled patients varied from 90 to 1570. Fifteen studies (65%) reported data on Asian populations [32,35,36,38,39,[42][43][44][46][47][48][49]51,53]. The adjuvant chemotherapy regimens were described only in six studies (anthracycline-and/or taxane-based regimens) [33,38,43,45,48,51].…”

“…In the univariate analysis, NLR was correlated with DFS in 14/17 articles (82%) [34,35,[37][38][39][40][41][42][44][45][46]46,47]. Among the 13 studies where multivariate models were used [34,35,[37][38][39][40][41][42]44,[46][47][48], only eight found that NLR was an independent prognostic factor for DFS [34,[37][38][39][40]46,48]. NLR: neutrophil to lymphocyte ratio, PLR: platelet to lymphocyte ratio, PCR: pathological complete response, DFS: disease free survival, OS: overall survival, CT: chemotherapy, NACT: neoadjuvant chemotherapy, ER: estrogen receptor, PR: progesterone receptor, BCSS: breast cancer specific survival, OR: odd ratio, HR: hazard ratio, BC: breast cancer, TNBC: triple negative breast cancer.…”

“…This analysis indicates that NLR is a reliable prognostic factor in localized BC treated with adjuvant chemotherapy. Indeed, in the 21/29 analyses (72.4%) where multivariate models were used, NLR was independently correlated with survival (DFS, BCSS and/or OS) [32,[34][35][36][37][38][39][40]46,[48][49][50][51]53].…”

“…Twenty-three articles reported data on NLR as a prognostic factor in patients receiving adjuvant treatment . Among the 29 multivariate analyses performed in these studies, 21 (72.4%) highlighted a positive correlation between NLR and survival [32,[34][35][36][37][38][39][40]46,[48][49][50][51]53], specifically DFS (11/17 analyses; 65%) [34,[37][38][39][40]46,[48][49][50]53], OS (8/9 analyses; 89%) [34,36,37,39,[49][50][51]53] and BCSS (2/3; 66%) [32,35]. In total, 18,153 patients were enrolled in these studies.…”