J Breast Cancer.  2011 Sep;14(3):204-212.

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

• Kim JY
• Ryu MR
• Choi BO
• Park WC
• Oh SJ
• Won JM
• Chung SM

Abstract

PURPOSE
This 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).
METHODS
The 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.
RESULTS
Median 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).
CONCLUSION
The 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.

Keyword

Breast neoplasms; Lymph nodes; Prognosis

MeSH Terms

Breast
Breast Neoplasms
Cohort Studies
Disease-Free Survival
Estrogens
Follow-Up Studies
Humans
Lymph Nodes
Multivariate Analysis
Neoplasm Metastasis
Prognosis
Receptors, Progesterone
Recurrence
Estrogens
Receptors, Progesterone

Figure

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  Figure 1 Disease-free survival (DFS) and disease-specific survival (DSS) of all patients stratified by pN stage and lymph node ratio (LNR), respectively. The LNR based classification (B, D) yields a statistically larger separation of the curves (larger χ2) compared to absolute number of the nodes (A, C).

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  Figure 2 Disease-free survival (DFS) and disease-specific survival (DSS) of stage lll patients stratified by pN stage and lymph node ratio (LNR) based classification, respectively. The LNR based classification (B, D) can distinguish subgroups more clearly than pN stage (A, C).

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