J Breast Cancer.  2016 Jun;19(2):169-175. 10.4048/jbc.2016.19.2.169.

Lymph Node Ratio as a Risk Factor for Locoregional Recurrence in Breast Cancer Patients with 10 or More Axillary Nodes

• Kim SW
• Choi DH
• Huh SJ
• Park W
• Nam SJ
• Kim SW
• Lee JE
• Im YH
• Ahn JS
• Park YH

• KMID: 2308968
• DOI: http://doi.org/10.4048/jbc.2016.19.2.169

Abstract

PURPOSE
We analyzed the association of lymph node ratio (LNR) wth locoregional control (LRC) in breast cancer patients with ≥10 involved axillary lymph nodes who underwent multimodality treatment.
METHODS
We retrospectively analyzed 234 breast cancer patients with ≥10 involved axillary lymph nodes between 2000 and 2011. All patients received adjuvant chemotherapy and radiotherapy (RT) after radical surgery. The cutoff value of LNR was obtained using receiver operating characteristic curve analysis. The majority of patients (87.2%) received chemotherapeutic regimen including taxane. RT consisted of tangential fields to the chest wall or intact breast, delivered at a median dose of 50 Gy, and a single anterior port to the supraclavicular lymph node area, delivered at a median dose of 50 Gy. For patients who underwent breast-conserving surgery, an electron boost with a total dose of 9 to 15 Gy was delivered to the tumor bed.
RESULTS
Within a median follow-up period of 73.5 months (range, 11-183 months), locoregional recurrence (LRR) occurred in 30 patients (12.8%) and the 5-year LRC rate was 88.8%. After multivariate analysis, LNR ≥0.7 was the only independent factor significantly associated with LRC (hazard ratio, 2.06; 95% confidence interval, 0.99-4.29; p=0.05).
CONCLUSION
An aggressive multimodal treatment approach showed favorable locoregional outcome in patients with ≥10 involved axillary lymph nodes. However, patients with a high LNR ≥0.7 still had an increased risk for LRR, even in the setting of current local treatments.

Keyword

Breast neoplasms; Local recurrence; Lymph node ratio

MeSH Terms

Breast Neoplasms*
Breast*
Chemotherapy, Adjuvant
Combined Modality Therapy
Follow-Up Studies
Humans
Lymph Nodes*
Mastectomy, Segmental
Multivariate Analysis
Radiotherapy
Recurrence*
Retrospective Studies
Risk Factors*
ROC Curve
Thoracic Wall

Figure

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  Figure 1 Kaplan-Meier curve of locoregional control rate for all patients.

• 

  Figure 2 Kaplan-Meier curve of locoregional control rate between lymph node ratio (LNR) ≥0.7 (solid line) and LNR <0.7 (dotted line).

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