Li-Ju Chen1, Kuo-Piao Chung2, Yao-Jen Chang3, Yun-Jau Chang4. 1. Graduate Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan; Department of Ophthalmology, Heping Branch, Taipei City Hospital, Taipei, Taiwan. 2. Graduate Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan. 3. Department of Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Foundation, Taipei, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan. 4. Department of General Surgery, National Taiwan University Hospital, Taipei, Taiwan; Department of General Surgery, Zhongxing Branch, Taipei City Hospital, Taipei, Taiwan. Electronic address: yunjauchang2003@gmail.com.
Abstract
PURPOSE: This study aimed to investigate the predictive role of lymph nodes (LNs) and assess the prognostic significance of the ratio of positive LNs (LNR) and log odds of positive LNs (LODDS) in breast cancer patients who have undergone a mastectomy. PATIENTS AND METHODS: All of the breast cancer patients in the Taiwan Cancer Database during 2002-2006 were considered. We excluded patients who had inflammatory breast cancer, stage 0 and IV disease, breast conservative surgery or survival <1 month. The primary end point was overall survival (OS). A Cox hazards model was constructed and compared via Nagelkerke R(2) (R(2)N) and receiver operating characteristics (ROC). RESULTS: A total of 11,349 (6042 node-negative, 5307 node-positive) patients were enrolled, and 10.5% patients had a limited number of LNs harvested. In a multivariate Cox model, LNR and LODDS demonstrated prognostic significance (<0.001). For node-positive patients, a model with LNR showed the best fit (P < 0.001; R(2)N = 18.2%) when sufficient LNs were examined. However, a model with LODDS showed the best fit in patients with a limited number of LNs harvested (P < 0.001; R(2)N = 21.1%), even in node-negative patients (P = 0.004; R(2)N = 13.5%). The area under the ROC curve (AUC) was highest for LODDS (AUC: 0.761), followed by LNR (AUC: 0.757). A limited LN harvest induced an AUC value for an approximate 3.6% loss (LNR) or 3.1% loss (LODDS). CONCLUSION: The prognostic superiority of LNR is confounded by a limited LN harvest, thus making LODDS the most powerful and unified prognostic classifier in breast cancer patients who have had a mastectomy.
PURPOSE: This study aimed to investigate the predictive role of lymph nodes (LNs) and assess the prognostic significance of the ratio of positive LNs (LNR) and log odds of positive LNs (LODDS) in breast cancerpatients who have undergone a mastectomy. PATIENTS AND METHODS: All of the breast cancerpatients in the Taiwan Cancer Database during 2002-2006 were considered. We excluded patients who had inflammatory breast cancer, stage 0 and IV disease, breast conservative surgery or survival <1 month. The primary end point was overall survival (OS). A Cox hazards model was constructed and compared via Nagelkerke R(2) (R(2)N) and receiver operating characteristics (ROC). RESULTS: A total of 11,349 (6042 node-negative, 5307 node-positive) patients were enrolled, and 10.5% patients had a limited number of LNs harvested. In a multivariate Cox model, LNR and LODDS demonstrated prognostic significance (<0.001). For node-positive patients, a model with LNR showed the best fit (P < 0.001; R(2)N = 18.2%) when sufficient LNs were examined. However, a model with LODDS showed the best fit in patients with a limited number of LNs harvested (P < 0.001; R(2)N = 21.1%), even in node-negative patients (P = 0.004; R(2)N = 13.5%). The area under the ROC curve (AUC) was highest for LODDS (AUC: 0.761), followed by LNR (AUC: 0.757). A limited LN harvest induced an AUC value for an approximate 3.6% loss (LNR) or 3.1% loss (LODDS). CONCLUSION: The prognostic superiority of LNR is confounded by a limited LN harvest, thus making LODDS the most powerful and unified prognostic classifier in breast cancerpatients who have had a mastectomy.
Authors: Woohyung Lee; Chi-Young Jeong; Young Hoon Kim; Young Hoon Roh; Myung Hee Yoon; Hyung Il Seo; Jeong-Ik Park; Bo-Hyun Jung; Dong Hoon Shin; Young Il Choi; Je Ho Ryu; Kwang Ho Yang; Chang Soo Choi; Yo-Han Park; Yang Won Nah; Soon-Chan Hong Journal: Langenbecks Arch Surg Date: 2019-08-14 Impact factor: 3.445