The prognostic role of lymph node ratio in breast cancer patients received neoadjuvant chemotherapy: A dose-response meta-analysis

Abstract

BackgroundAs neoadjuvant chemotherapy is widely used in breast cancer patients, the lymph node ratio has not been fully validated as a prognostic indicator of breast cancer received neoadjuvant chemotherapy. This study was conducted to investigate the prognostic value of lymph node ratio in breast cancer patients received neoadjuvant chemotherapy.MethodsSystematic searches were performed in the PubMed, Embase, and Cochrane Library databases until 15 December 2021 for studies on the association between lymph node ratio and the prognosis of breast cancer after neoadjuvant chemotherapy. Overall survival and disease-free survival were used as outcome events, and hazard ratio was chosen as the parameter to evaluate the correlation. The dose-response relationship was assessed by restricted cubic splines. In the subgroup analyses, which were used to explore potential heterogeneity among the included studies according to study region and sample size. Sensitivity analysis was performed to assess the stability of individual studies, and publication bias was determined with funnel plots, Begg’s test, and Egger's test. All statistical analyses were performed using Stata 15.1.ResultsA total of 12 studies with 4,864 patients were included in this meta-analysis. In this study, high lymph node ratio was significantly associated with decreased overall survival (HR: 4.74; 95%CI: 3.36–6.67; P < 0.001) and disease-free survival (HR: 4.77; 95%CI: 3.69–6.17; P < 0.001). Moreover, the dose-response meta-analysis showed a linear association between higher lymph node ratio and shorter overall survival and disease-free survival in breast cancer patients after neoadjuvant chemotherapy.ConclusionsThe meta-analysis suggested that high lymph node ratio was significantly associated with short overall survival and disease-free survival in breast cancer patients after neoadjuvant chemotherapy. Therefore, lymph node ratio is an independent predictive factor for the prognosis of breast cancer patients after neoadjuvant chemotherapy, which may better refine the cancer staging system.

Molecular and metabolic orchestration of the lymphatic vasculature in physiology and pathology

“…In these types of cancer, LNs are the first sites to be invaded. Indeed, the presence or absence of cancer cells in the first draining LN (also known as sentinel LN) has been recognized as a prognostic factor in several human cancers, often being even more reliable than already established clinical parameters such as tumor size or histological grade 100 , 101 .…”

Pretreatment Circulating Albumin, Platelet, and RDW-SD Associated with Worse Disease-Free Survival in Patients with Breast Cancer

“…[8][9][10][11] Furthermore, previous studies have shown that factors related to a shorter disease-free survival (DFS) include lymph node involvement, tumors larger than 2 cm, and triple negative hormone receptor status. [12][13][14] Moreover, therapeutic modalities for breast cancer may also significantly affect DFS. Bundred et al found that involved or close pathological margins after breast conserving surgery for early-stage invasive breast cancer were associated with increased distant recurrence and local recurrence.…”

Twenty-five Years Overall Survival Prognostic Value of the Lymph Node Ratio inDe NovoMetastatic Breast Cancer

“…This survival relationship suggests better reliability of the lymph node ratio. An abundant literature showed the advantage of a ratio-based classification over conventional numbers in nonmetastatic disease in various conditions (9,10). Considering that non-optimal categorization of lymph nodes might have confounded prognostic groups in dnMBC, the present study sought to evaluate whether nodal ratios provide prognostic information in dnMBC.…”