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

Abstract

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.

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

“…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.…”

“…Interestingly, most studies had similar observations. 12,[15][16][17][18] Thus, it may be interpreted that ALN involvement in[25% of the excised nodes is associated with a poor outcome. The outcome greatly worsens with increasing ALNR.…”

“…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.…”

Exploring Factors Related to Metastasis Free Survival in Breast Cancer Patients Using Bayesian Cure Models

“…There is a common belief that lymph node involvement is the best marker to recognize metastatic potential of breast cancer as the 5-year survival rate decreases by approximately 40% in the presence of lymph node involvement (van der Wal et al, 2002;Weigelt et al, 2005). The cut off value of 25% for this factor has been reported to be a useful in determining high risk groups of patients (Truong et al, 2005). The results provide a guide for clinicians in the prognosis and assessing progression of the disease.…”

“…Several studies have used different statistical methods to determine the prognostic factors of secondary breast metastasis. According to the literature, estrogen receptor (ER), progesterone receptor (PR), lymph node involvement ratio (LNR), cathepsin-D (Cath-D), tumor protein 53 (p53) , human epidermal growth factor receptor type 2 (Her2 also known as ERBB2 or HER-2/neu), tumor size, age at diagnosis, chemotherapy, and axillary nodal status at the time of diagnosis of the primary tumor are the most important prognostic factors with different impact on progression and metastases of breast cancer to various organs (Rochefort et al, 1990;Veronesi et al, 1993;Garcia et al, 1996;Inoue et al, 1998;Balleine et al, 1999;Rochefort and Liaudent-coopman, 1999;Selzner et al, 2000;Evans et al, 2004;Colleoni et al, 2005;Truong et al, 2005;Voogd et al, 2005;Weigelt et al, 2005;Palmieria et al, 2006Palmieria et al, , 2007Altundag et al, 2007;Sezgin et al, 2007;Wadasadawala et al, 2007;Gao et al, 2009;Koizumi et al, 2010;Ruiterkamp et al, 2011;Senkus et al, 2013).…”