Value of Metastatic Lymph Node Ratio for Predicting Prognosis of Patients with Node-Positive Breast Cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LI Yongfeng ¹ , WU Yunfei ¹ , ZHANG Hui ²

1.Department of Breast Surgery, The First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China;;
2.Department of Clinical Laboratory, The First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China;

Corresponding author：

Keywords：

Breast cancer; Lymph node excision; Neoplasm metastasis; Neoplasm staging; Prognosis

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ObjectiveTo evaluate the prognostic significance of metastatic lymph nodes ratio (MLNR) in patients with node-positive breast cancer. MethodsThe clinical data of 94 patients with nodepositive breast cancer underwent modified radical mastectomy were retrospectively analyzed. The survival rate and prognosis factors of patients with complete follow-up data were assessed by log-rank test and multivariate regression analysis. Results The survival time of 94 patients ranged from 12-75 months, with median 64 months. The 5-year overall survival rate was 72.34% (68/94). The total MLNR was 0.31 (486/1 553). Univariate analysis demonstrated that the survival was influenced significantly by tumor size, number of lymph node metastasis, MLNR, ER status, and radiotherapy or not (P lt;0.05), but not by patient’s age, menopause or not, PR status, endocrine therapy or not, and histological type (P gt;0.05). Multivariate analysis showed that MLNR (OR=2.565, 95%CI=1.043-6.309， P=0.040) and tumor size (OR=2.220, 95%CI=1.045-4.716， P=0.038) were independent prognostic factors for the patients with node-positive breast cancer. Conclusion MLNR is a major independent prognostic factor for the patients with node-positive breast cancer, which is more accurate than the number of metastatic lymph nodes in predicting the survival of patients with node-positive breast cancer.

Citation： LI Yongfeng ,WU Yunfei,ZHANG Hui. Value of Metastatic Lymph Node Ratio for Predicting Prognosis of Patients with Node-Positive Breast Cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2011, 18(7): 750-754. doi: Copy

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19.	梁峰, 张宏艳, 陈济生, 等. 哨兵淋巴结活检对乳腺癌腋窝淋巴结转移的预测 [J]. 中国现代医学杂志, 2010, 20(11): 16981700.
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24.	Megale Costa LJ, Soares HP, Gaspar HA, et al. Ratio between positive lymph nodes and total dissected axillary lymph nodes as an independent prognostic factor for diseasefree survival in patients with breast cancer [J]. Am J Clin Oncol, 2004, 27(3): 304306.
25.	Hatoum HA, Jamali FR, ElSaghir NS, et al. 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 [J]. Ann Surg Oncol, 2009, 16(12): 33883395.
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1. VinhHung V, Burzykowski T, Cserni G, et al. Functional form of the effect of the numbers of axillary nodes on survival in early breast cancer [J]. Int J Oncol, 2003, 22(3): 679704.
2. VinhHung V, Cserni G, Burzykowski T, et al. Effect of the number of uninvolved nodes on survival in early breast cancer [J]. Oncol Rep, 2003, 10(2): 363368.
3. Woodward WA, Strom EA, Tucker SL, et al. Changes in the 2003 American Joint Committee on Cancer staging for breast cancer dramatically affect stagespecific survival [J]. J Clin Oncol, 2003, 21(17): 32443248.
4. Kuru B. Prognostic significance of total number of nodes removed, negative nodes removed, and ratio of positive nodes to removed nodes in node positive breast carcinoma [J]. Eur J Surg Oncol, 2006, 32(10): 10821088.
5. Voordeckers M, VinhHung V, Van de Steene J, et al. The lymph node ratio as prognostic factor in nodepositive breast cancer [J]. Radiother Oncol, 2004, 70(3): 225230.
6. VinhHung V, Verkooijen HM, Fioretta G, et al. Lymph node ratio a an alternative to pN staging in nodepositive breast cancer [J]. J Clin Oncol, 2009, 27(7): 10621068.
7. Van Lancker M, Goor C, Sacre R, et al. Patterns of axillary lymph node metastasis in breast cancer [J]. Am J Clin Oncol, 1995, 18(3): 267272.
8. 廖宁, 王坤, 吴一龙. NCCN乳腺癌临床指引(2003.2版) [J]. 循证医学, 2003, 3(3): 167192.
9. Truong PT, Berthelet E, Lee J, et al. 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 [J]. Cancer, 2005, 103(10): 20062014.
10. 陈先有, 陈玉泉. 乳腺癌改良根治术中部分腋窝淋巴结清扫的远期疗效分析 [J].中国普外基础与临床杂志, 2009, 16(7): 527530.
11. MartinezRamos D, EscrigSos J, AlcaldeSanchez M, et al. Diseasefree survival and prognostic significance of metastatic lymph node ratio in T1T2 N positive breast cancer patients. A population registrybased study in a European country [J]. World J Surg, 2009, 33(8): 16591664.
12. Rivadeneira DE, Simmons RM, Christos PJ, et al. Predictive factors associated with axillary lymph node metastases in T1a and T1b breast carcinomas: analysis in more than 900 patients [J]. J Am Coll Surg, 2000, 191(1): 18.
13. Maibenco DC, Weiss LK, Pawlish KS, et al. Axillary lymph node metastases associated with small invasive breast carcinomas [J]. Cancer, 1999, 85(7): 15301536.
14. Taghian A, Jeong JH, Mamounas E, et al. Patterns of locoregional failure in patients with operable breast cancer treated by mastectomy and adjuvant chemotherapy with or without tamoxifen and without radiotherapy: results from five National Surgical Adjuvant Breast and Bowel Project randomized clinical trials [J]. J Clin Oncol, 2004; 22(21): 42474254.
15. 孟洁. 年轻乳腺癌发生及预后因素筛选研究 [D]. 天津：天津医科大学, 2007: 129.
16. Woodward WA, VinhHung V, Ueno NT, et al. Prognostic value of nodal ratios in nodepositive breast cancer [J]. J Clin Oncol, 2006, 24(18): 29102916.
17. Krag DN, Anderson SJ, Julian TB, et al. Technical outcomes of sentinellymphnode resection and conventional axillarylymphnode dissection in patients with clinically nodenegative breast cancer: results from the NSABP B32 randomised phase Ⅲ trial [J]. Lancet Oncol, 2007, 8(10): 881888.
18. 申郑堂, 王守满, 罗沙阳. 乳腺癌局部进展期新辅助化疗后哨兵淋巴结活检准确性的临床观察 [J]. 中国医学工程, 2006, 14(6): 583585, 589.
19. 梁峰, 张宏艳, 陈济生, 等. 哨兵淋巴结活检对乳腺癌腋窝淋巴结转移的预测 [J]. 中国现代医学杂志, 2010, 20(11): 16981700.
20. 钟颖, 孙强, 徐雅莉, 等. 30年乳腺癌治疗趋势的变化 [J]. 中国普外基础与临床杂志, 2009, 16(11): 911917.
21. 薛卫成, 阚秀. 介绍乳腺癌TNM分期系统(第6版) [J]. 诊断病理学杂志, 2008， 15(3): 161164.
22. Krag DN, Single RM. Breast cancer survival according to number of nodes removed [J]. Ann Surg Oncol, 2003, 10(10): 11521159.
23. van der Wal BC, Butzelaar RMJM, van der Meij S, et al. Axillary lymph node ratio and total number of removed lymph nodes: predictors of survival in stage Ⅰ and Ⅱ breast cancer [J]. Eur J Surg Oncol, 2002, 28(5): 481489.
24. Megale Costa LJ, Soares HP, Gaspar HA, et al. Ratio between positive lymph nodes and total dissected axillary lymph nodes as an independent prognostic factor for diseasefree survival in patients with breast cancer [J]. Am J Clin Oncol, 2004, 27(3): 304306.
25. Hatoum HA, Jamali FR, ElSaghir NS, et al. 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 [J]. Ann Surg Oncol, 2009, 16(12): 33883395.
26. 梅欣, 郭小毛, 章倩. 乳腺癌术后腋窝淋巴结转移对放疗的指导意义 [J]. 临床肿瘤学杂志, 2006, 11(4): 295299.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Value of Metastatic Lymph Node Ratio for Predicting Prognosis of Patients with Node-Positive Breast Cancer

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