The lymph node ratio as prognostic factor in node-positive breast cancer

Voordeckers, Mia; Vinh-Hung, Vincent; Steene, Jan Van de; Lamote, Jan; Storme, Guy

doi:10.1016/j.radonc.2003.10.015

Cited by 131 publications

(105 citation statements)

References 16 publications

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“…11,25 In an attempt to address the above, several studies have focused on the utility of the ALNR as an independent prognostic indicator of OS. [12][13][14][15][16][17][18] Our study demonstrates a statistically significant negative correlation between ALNR and OS, thus supporting the findings of previous studies (Table 5). [12][13][14][15][16][17][18] The strength of the data in the present study draws on the following factors.…”

Section: Discussionsupporting

confidence: 91%

“…29 Our data support studies that suggest that ALNR is a stronger prognostic factor for OS than the absolute number of pALN. 13,[16][17][18] In our multivariate model, when ALNR was included in the Cox analysis, the number of pALN lost its significance as an independent predictor of BC survival. Our data also show that among the initially assigned ALNR groups, statistically significant survival difference is only found when comparison was made with the\.25 subgroup, thus advocating the use of an ALNR of .25 as a cutoff.…”

Section: Discussionmentioning

confidence: 93%

“…14,18 Moreover, in many of these series, additional factors affecting OS, such as tumor receptor status (including HER2) and use of neoadjuvant or adjuvant treatment regimens, were not considered. [12][13][14][15][16][17][18] We thus report a single institutional experience with the prognostic significance of ALNR in nonmetastatic lymph node-positive BC patients treated by the same medical and surgical oncology team while attempting to address many of the shortcomings evident in some of the previous trials.…”

Section: Introductionmentioning

confidence: 99%

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Ratio Between Positive Lymph Nodes and Total Excised Axillary Lymph Nodes as an Independent Prognostic Factor for Overall Survival in Patients with Nonmetastatic Lymph Node-Positive Breast Cancer

Hatoum

Jamali

El-Saghir

et al. 2010

Indian J Surg Oncol

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Background. The status of the axillary lymph nodes in nonmetastatic lymph node-positive breast cancer (BC) patients remains the single most important determinant of overall survival (OS). Although the absolute number of nodes involved with cancer is important for prognosis, the role of the total number of excised nodes has received less emphasis. Thus, several studies have focused on the utility of the axillary lymph node ratio (ALNR) as an independent prognostic indicator of OS. However, most studies suffered from shortcomings, such as including patients who received neoadjuvant therapy or failing to consider the use of adjuvant therapy and tumor receptor status in their analysis. Methods. We conducted a single-center retrospective review of 669 patients with nonmetastatic lymph nodepositive BC. Data collected included patient demographics; breast cancer risk factors; tumor size, histopathological, receptor, and lymph node status; and treatment modalities used. Patients were subdivided into four groups according to ALNR value (\.25, .25-.49, .50-.74, .75-1.00). Study parameters were compared at the univariate and multivariate levels for their effect on OS.Results. On univariate analysis, both the absolute number of positive lymph nodes and the ALNR were significant predictors of OS. On multivariate analysis, only the ALNR remained an independent predictor of OS, with a 2.5-fold increased risk of dying at an ALNR of C.25. Conclusions. Our study demonstrates that ALNR is a stronger factor in predicting OS than the absolute number of positive axillary lymph nodes.Breast cancer (BC) is the most common cancer in women and the second most common cause of female cancer death, with an estimated 182,460 new cases diagnosed and 40,480 deaths in the United States in 2008. 1 Despite the advent of sentinel node biopsy techniques and the dawning of the molecular era of BC staging, the status of the axillary lymph nodes (ALN) remains the single most important determinant of overall survival (OS). [2][3][4][5][6] For patients with pathologically proven ALN involvement, the number of positive axillary lymph nodes (pALN) correlates with the incidence of distant metastasis and OS, and more than three pALN is associated with a 13% to 24% locoregional recurrence rate. 7,8 The relationship between number of pALN and survival seems to be linear, with each additional pALN detected leading to a worsening of the prognosis. 9,10 The American Joint Committee on Cancer staging system was recently revised, grouping patients by the absolute number of pALN. This classification improved stratification in OS, but the confounding effect that the number of excised nodes may have on the yield of positive nodes and its effect on BC-specific survival prognostic accuracy and management decisions are problems that remain unresolved. 6,11 Thus, the ratio between the number of pALN and the total number of excised nodes, or the axillary lymph node ratio (ALNR), may be a more comprehensive approach to estimate prognosis because it takes into accou...

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

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Ratio Between Positive Lymph Nodes and Total Excised Axillary Lymph Nodes as an Independent Prognostic Factor for Overall Survival in Patients with Nonmetastatic Lymph Node-Positive Breast Cancer

Hatoum

Jamali

El-Saghir

et al. 2010

Indian J Surg Oncol

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“…Ratio-based lymph node staging has been shown to be prognostic of survival in patients with gastric, breast, bladder, and pancreatic cancers [10,[12][13][14][15]. The impact of metastatic lymph node ratio (LNR) on prognosis has also been assessed in colon cancer [16].…”

Section: Introductionmentioning

confidence: 99%

Nodal stage of stage III colon cancer: The impact of metastatic lymph node ratio

Park

Choi

Jun

2009

Journal of Surgical Oncology

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Purpose:We assessed which classification of lymph node metastasis better predicted outcomes in patients with colorectal carcinoma. Methods: We identified 318 patients (176 men) with stage III colon cancer who underwent curative resection. The number of LNs dissected, LNR, and disease-free survival time, were analyzed. Lymph node disease was stratified by the American Joint Committee on Cancer staging and LNR, with the latter categorized into groups with LNR <0.059 (n ¼ 67), 0.059-0.23 (n ¼ 171), and >0.23 (n ¼ 80). Median follow-up time was 37 (range, 1-122) months. Results: LNR significantly increased with the number of metastatic LNs (P < 0.0001). Three-year disease-free survival (DFS) rates differed significantly in the three LNR groups. Within each TNM stage, 3-year DFS rates differed according to LNR, but, within each LNR subgroup, 3-year DFS did not differ according to TNM stage. When both TNM stage and LNR subgroup were considered, 3-year DFS was stratified into four groups, which differed significantly (P < 0.0001). Considering number of retrieved lymph nodes, this stratification was not found when <12 lymph nodes retrieved. Conclusions: Re-stratified lymph node staging, reflecting both LNR and TNM stage, can predict survival in patients with LN-positive colon cancer, especially when more than 12 lymph nodes harvested.

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“…[11][12][13] However, relatively few data are available to define the effect of the percentage of positive lymph nodes on risks of LRR. Because postmastectomy radiotherapy has the potential to optimize locoregional control and improve survival, 4 -6,14 we were interested in evaluating whether the percentage of positive lymph nodes may be applied in patients with one to three positive lymph nodes to distinguish those at high risk who may benefit with adjuvant therapy from those at low risk who may be spared treatment-related toxicities.…”

mentioning

confidence: 99%

The prognostic significance of the percentage of positive/dissected axillary lymph nodes in breast cancer recurrence and survival in patients with one to three positive axillary lymph nodes

Truong

Berthelet

Lee

et al. 2005

Cancer

126

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BACKGROUNDAdjuvant therapy for women with T1–T2 breast carcinoma and 1–3 positive lymph nodes is controversial due to discrepancies in reported baseline locoregional recurrence (LRR) risks. This inconsistency has been attributed to variations in lymph node staging techniques, which have yielded different numbers of dissected lymph nodes. The current study evaluated the prognostic impact of the percentage of positive/dissected lymph nodes on recurrence and survival in women with one to three positive lymph nodes.METHODSThe study cohort was comprised of 542 women with pathologic T1–T2 breast carcinoma who had 1–3 positive lymph nodes and who had undergone mastectomy and received adjuvant systemic therapy without radiotherapy. Ten‐year Kaplan–Meier (KM) LRR, distant recurrence (DR), and overall survival (OS) rates stratified by the number of positive lymph nodes, the number of dissected lymph nodes, and the percentage of positive lymph nodes were examined using different cut‐off levels. Multivariate analysis was performed to evaluate the prognostic significance of the percentage of positive lymph nodes in disease recurrence and survival.RESULTSThe median follow‐up was 7.5 years. LRR, DR, and OS rates correlated significantly with the number of positive lymph nodes and the percentage of positive lymph nodes, but not with the number of dissected lymph nodes. The cut‐off level at which the most significant difference in LRR was observed was 25% positive lymph nodes (the 10‐year KM LRR rates were 13.9% and 36.7% in women with ≤ 25% and > 25% positive lymph nodes, respectively; P < 0.0001). Higher DR rates and lower OS rates were observed among patients who had > 25% positive lymph nodes compared with patients who had ≤ 25% positive lymph nodes (DR: 53.0% vs. 30.3%, respectively; P < 0.0001; OS: 43.4% vs. 62.6%, respectively; P < 0.0001). In the multivariate analysis, the percentage of positive lymph nodes and the histologic grade were significant, independent factors associated with LRR, DR, and OS.CONCLUSIONSThe presence of > 25% positive lymph nodes was an adverse prognostic factor in patients with 1–3 positive nodes and may be used to identify patients at high risks of postmastectomy locoregional and distant recurrence who may benefit with adjuvant radiotherapy and more aggressive systemic therapy regimens. Cancer 2005. © 2005 American Cancer Society.

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The lymph node ratio as prognostic factor in node-positive breast cancer

Cited by 131 publications

References 16 publications

Ratio Between Positive Lymph Nodes and Total Excised Axillary Lymph Nodes as an Independent Prognostic Factor for Overall Survival in Patients with Nonmetastatic Lymph Node-Positive Breast Cancer

Ratio Between Positive Lymph Nodes and Total Excised Axillary Lymph Nodes as an Independent Prognostic Factor for Overall Survival in Patients with Nonmetastatic Lymph Node-Positive Breast Cancer

Nodal stage of stage III colon cancer: The impact of metastatic lymph node ratio

The prognostic significance of the percentage of positive/dissected axillary lymph nodes in breast cancer recurrence and survival in patients with one to three positive axillary lymph nodes

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