BACKGROUND: The aim of the present study was to determine how lymph node ratio (LNR; the ratio of the number of metastatic lymph nodes to the number of removed lymph nodes) can supplement the TNM nodal classification in breast carcinoma. METHODS: We retrospectively reviewed the file records of 2,151 patients. RESULTS: Lymph node ratio-based low- (LNR ≤ 0.20), intermediate- (LNR 0.21-0.65), and high-risk (LNR > 0.65) patient groups had significantly different disease-free survival (DFS) (P < 0.001). The DFS of patients with N1, N2, and N3 disease was significantly different (P < 0.001). When LNR and TNM nodal groupings were included together in the Cox analysis, both groupings had independent prognostic significance (P < 0.001 and P < 0.001, respectively). The most significant LNR threshold value separating patients in low-risk and high-risk groups in terms of disease recurrence was 0.20 for N1 disease (P < 0.001), 0.35 for N2 disease (P < 0.001), and 0.90 for N3 disease (P < 0.001). CONCLUSIONS: Lymph node ratio and TNM nodal groupings show no superiority over each other in categorizing patients with node-positive breast carcinoma into prognostic groups of low-, intermediate-, and high-risk. However, LNR grouping may supplement TNM nodal classification by categorizing patients within each TNM nodal group into low-risk and high-risk groups with significantly different survival.
BACKGROUND: The aim of the present study was to determine how lymph node ratio (LNR; the ratio of the number of metastatic lymph nodes to the number of removed lymph nodes) can supplement the TNM nodal classification in breast carcinoma. METHODS: We retrospectively reviewed the file records of 2,151 patients. RESULTS: Lymph node ratio-based low- (LNR ≤ 0.20), intermediate- (LNR 0.21-0.65), and high-risk (LNR > 0.65) patient groups had significantly different disease-free survival (DFS) (P < 0.001). The DFS of patients with N1, N2, and N3 disease was significantly different (P < 0.001). When LNR and TNM nodal groupings were included together in the Cox analysis, both groupings had independent prognostic significance (P < 0.001 and P < 0.001, respectively). The most significant LNR threshold value separating patients in low-risk and high-risk groups in terms of disease recurrence was 0.20 for N1 disease (P < 0.001), 0.35 for N2 disease (P < 0.001), and 0.90 for N3 disease (P < 0.001). CONCLUSIONS: Lymph node ratio and TNM nodal groupings show no superiority over each other in categorizing patients with node-positive breast carcinoma into prognostic groups of low-, intermediate-, and high-risk. However, LNR grouping may supplement TNM nodal classification by categorizing patients within each TNM nodal group into low-risk and high-risk groups with significantly different survival.
Authors: Wendy A Woodward; Vincent Vinh-Hung; Naoto T Ueno; Yee Chung Cheng; Melanie Royce; Patricia Tai; Georges Vlastos; Anne Marie Wallace; Gabriel N Hortobagyi; Yago Nieto Journal: J Clin Oncol Date: 2006-06-20 Impact factor: 44.544
Authors: Suzanne C Schiffman; Kelly M McMasters; Charles R Scoggins; Robert C Martin; Anees B Chagpar Journal: J Am Coll Surg Date: 2011-05-20 Impact factor: 6.113
Authors: B Fisher; M Bauer; D L Wickerham; C K Redmond; E R Fisher; A B Cruz; R Foster; B Gardner; H Lerner; R Margolese Journal: Cancer Date: 1983-11-01 Impact factor: 6.860