The Prognostic Significance of the Lymph Node Ratio in Axillary Lymph Node Positive Breast Cancer

Abstract

PurposeThis study evaluated the prognostic impact of the lymph node ratio (LNR; i.e., the ratio of positive to dissected lymph nodes) on recurrence and survival in breast cancer patients with positive axillary lymph nodes (LNs).MethodsThe study cohort was comprised of 330 breast cancer patients with positive axillary nodes who received postoperative radiotherapy between 1987 and 2004. Ten-year Kaplan-Meier locoregional failure, distant metastasis, disease-free survival (DFS) and disease-specific survival (DSS) rates were compared using Kaplan-Meier curves. The prognostic significance of the LNR was evaluated by multivariate analysis.ResultsMedian follow-up was 7.5 years. By minimum p-value approach, 0.25 and 0.55 were the cutoff values of LNR at which most significant difference in DFS and DSS was observed. The DFS and DSS rates correlated significantly with tumor size, pN classification, LNR, histologic grade, lymphovascular invasion, the status of estrogen receptor and progesterone receptor. The LNR based classification yielded a statistically larger separation of the DFS curves than pN classification. In multivariate analysis, histologic grade and pN classification were significant prognostic factors for DFS and DSS. However, when the LNR was included as a covariate in the model, the LNR was highly significant (p<0.0001), and pN classification was not statistically significant (p>0.05).ConclusionThe LNR predicts recurrence and survival more accurately than pN classification in our study. The pN classification and LNR should be considered together in risk estimates for axillary LNs positive breast cancer patients.

Lymph node ratio as an alternative to pN staging for predicting prognosis after neoadjuvant chemotherapy in breast cancer

“…Our retrospective analysis of 236 patients who received NAC revealed that LNR was a more significant prognostic factor than nodal stage. Previous studies that mostly reported patients who did not undergo NAC demonstrated the oncologic importance of the LNR as a predictor of prognosis in breast cancer [5–7]. Only a few studies have focused on patients who received NAC.…”

“…The extent of axillary dissection varies according to the surgeon and there is further variation in the number of reported positive nodes across different pathology laboratories [4]. More extensive axillary dissection or pathologic examination of the resected specimen results in a higher number of positive nodes [5]. Recent studies have reported the oncologic importance of the lymph node ratio (LNR), defined as the ratio of involved nodes to dissected nodes, as a predictor of prognosis in breast cancer [5–8].…”

The lymph node ratio as an independent prognostic factor for node-positive triple-negative breast cancer

“…Compared with the number-based staging system, the LNR classification model exploits additional information on the total number of lymph nodes removed. Increasing evidence is establishing the prognostic role of the LNR in breast cancer [ 10 , 18 – 21 ]. Our results support previous findings, demonstrating that the LNR is a prognostic factor in both multivariate and univariate analyses.…”

Lobular ectopic breast carcinoma: A case-report

“…The prognosis is similar compared with carcinoma of the anatomic breast with the same tumor stage and histology, although ectopic axillary breast carcinoma has a higher rate of lymph node involvement, 4,6,11 which is a known important prognostic factor for overall survival. 13,14…”