Breast cancer preoperative 18FDG-PET, overall survival prognostic separation compared with the lymph node ratio

Vinh-Hung, Vincent; Everaert, Hendrik; Gorobets, Olena; Parijs, Hilde Van; Verfaillie, Guy; Vanhoeij, Marian; Storme, Guy; Fontaine, Christel; Lamote, Jan; Perrin, Jean-Philippe; Farid, Karim; Nguyen, Nam P.; Verschraegen, Claire F.; Ridder, Mark De

doi:10.1007/s12282-021-01234-z

Cited by 6 publications

(7 citation statements)

References 37 publications

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“…Ultimately, univariate analysis demonstrated unfavorable BCSS and OS were related with the LNR above the cutoff value in T1/2 breast cancer patients, which is a result similar to that obtained by Vinh-Hung (18,26). However, in multivariate analysis, only the TNBC subtype was an independent predictor of reduced BCSS and OS, which may be because of a different case source and the number of early-stage patients in our cohort (7,10).…”

Section: Discussionsupporting

confidence: 86%

“…In particular, we demonstrated correlation of the LNR with preoperational sex hormone concentration in postmenopausal cases, and revealed that FSH and LH levels were significantly negatively associated with the LNR, whereas CA153 and CEA were positively correlated with it in whole cohort. While pN status was a crucial factor for anatomic TNM staging for the prediction of metastasis and prognosis of breast cancer patients, recent studies suggest the LNR is more accurate than pN status by reducing the variability of lymph node dissection and the standardization may be set up in the near future (6,10,18). We identified the cut-off value of the LNR as 0.042 based on our cohort, which was lower than that be reported in other studies, and may be because a greater percentage of our patients had early-stage disease, and there were different patient sources between institutions (19,20).…”

Section: Discussionmentioning

confidence: 99%

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Potential prognostic value of the lymph node ratio and its correlation with circulating sex hormone concentration in pathological T1/2 breast cancer patients: a retrospective study

Zhu¹,

Qiu²,

Lin³

et al. 2022

Ann Transl Med

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Background: The lymph node ratio (LNR) is an additional informative factor complementing anatomic TNM staging in breast cancer patients. The aim of this study was to evaluate the role of LNR in the cancerspecific and overall survival (OS) in a cohort of pT1/2 breast cancer patients and examine its correlation with circulating sex hormone concentrations in postmenopausal cases of the cohort from eastern China islands.Methods: Clinical and pathological characteristics, preoperational sex hormone and tumor markers concentrations, and breast cancer-specific survival (BCSS) and OS were analyzed retrospectively in 732 pathological T1/2 breast cancer patients. Results:The LNR was calculated, and the cut-off value was defined as 0.042 by receiver operative characteristic (ROC) curve according to the patient's mortalities. Patients with LNR ≥0.042 exhibited worse BCSS and OS than others (P<0.001) in pT1/2 breast cancer. Among patients with non-triple negative breast cancer (TNBC) and TNBC subtypes, the LNR ≥0.042 group also exhibited worse BCSS and OS than the LNR <0.042 group (P=0.003, 0.001, and P=0.032, 0.001, respectively). In univariate analysis, unfavorable BCSS and OS were both related with LNR ≥0.042 (P=0.001, <0.001). However multivariate analysis demonstrated TNBC subtypes were independent predictor for BCSS and OS [hazard ratio (HR) =1.449, 95% CI: 1.097-1.914, P=0.009; HR =1.365, 95% CI: 1.093-1.705, P=0.006, respectively]. Notably, Pearson or spearman correlation analysis revealed follicle-stimulating hormone (FSH) and, luteinizing hormone (LH) levels were significantly negatively associated with the LNR (P=0.007, 0.011, respectively) in postmenopausal cases, whereas CA153, CA125 and CEA were positively correlated with it (P<0.001, <0.001, 0.001, respectively) in all cases.Conclusions: Among pT1/2 breast cancer patients from eastern China islands, the LNR is a predictive prognosis factor; a higher LNR seems to correlate with a worse survival outcome both overall and in the subgroups. Strikingly, the current results reveal that serum FSH and LH level inversely associated with axillary node invasion in postmenopausal cases, whereas tumor markers directly related with it. The LNR is ^ ORCID: 0000-0003-4805-0800.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Potential prognostic value of the lymph node ratio and its correlation with circulating sex hormone concentration in pathological T1/2 breast cancer patients: a retrospective study

Zhu¹,

Qiu²,

Lin³

et al. 2022

Ann Transl Med

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“…In a study comparing preoperative FDG-PET with the lymph node ratio, the survival prognostic value of PET came close to that of the lymph node ratio. 30 These observations suggest that FDG-PET might be a surrogate prognostic indicator and could help to select the type or the intent of axillary surgery, for disease control, or for diagnostic-prognostic purpose. Limitations of the study include the relatively small sample size which did not allow detailed subgroup analyses.…”

Section: Discussionmentioning

confidence: 97%

Lymph Node Ratio after Neoadjuvant Chemotherapy for Stage II/III Breast Cancer: Prognostic Value Measured with Gini’s Mean Difference of Restricted Mean Survival Times

et al. 2021

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Restricted mean survival time (RMST), recommended for reporting survival, lacks a tool to evaluate multilevel factors. The potential of the Gini’s mean difference of RMSTs (Δ) is explored in a comparison of a lymph node ratio-based classification (LNRc) versus a number-based classification (ypN) applied to stage II/III breast cancer patients who received neoadjuvant chemotherapy and underwent axillary dissection. Number of positive nodes ( npos) classified patients into ypN0, npos = 0, ypN1, npos = [1,3], ypN2, npos = [4,9], and ypN3, npos ⩾ 10. Ratio npos/( number of nodes examined) of 0, (0,0.20], (0.20,0.65], and >0.65, classified patients into Lnr0 to Lnr3, respectively. Unadjusted and Cox-adjusted RMSTs were computed for the ypN and LNRc’s. At a follow-up time horizon of 72 months for 114 node-negative and 254 node-positive patients, unadjusted ypN0-ypN3 RMSTs were 62.4-41.4 months, Δ = 11.9 months (95%CI: 7.4-16.9), and Lnr0-Lnr3 62.4 to 36.3 months, Δ = 14.0 months (95%CI: 10.1-18.1). Cox models’ ypN1-ypN3 hazard ratios were 1.81-3.30, and Lnr1-Lnr3 1.52-4.39. Δ from Cox-fitted survival were ypN 8.1 months (95%CI: 5.9-10.5), LNRc 10.5 months (95%CI: 8.4-12.8). In conclusion, Gini’s mean difference is applicable to well established data in keeping with the literature on LNRc. It provides an alternative view on the improvement gained with a lymph node ratio-classification over using a number-classification.

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“…On the third facet, how to compare the outcomes, the RMST literature and available software have been limited to the comparison of two groups 10 . We used the lymph node ratio with RMST in a recent study 12 ; comparisons had to reduce to a single 0.20 cutoff. Reducing to two groups did the job in the context of that study, but would not be satisfying in a formal comparison of classifications of four or more pre-established groups.…”

Section: Introductionmentioning

confidence: 99%

Gini's mean difference and the long-term prognostic value of nodal quanta classes after pre-operative chemotherapy in advanced breast cancer

Vinh-Hung

Parijs

Gorobets

et al. 2022

Sci Rep

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Gini's mean difference (GMD, mean absolute difference between any two distinct quantities) of the restricted mean survival times (RMSTs, expectation of life at a given time limit) has been proposed as a new metric where higher GMD indicates better prognostic value. GMD is applied to the RMSTs at 25 years time-horizon to evaluate the long-term overall survival of women with breast cancer who received neoadjuvant chemotherapy, comparing a classification based on the number (pN) versus a classification based on the ratio (LNRc) of positive nodes found at axillary surgery. A total of 233 patients treated in 1980–2009 with documented number of positive nodes (npos) and number of nodes examined (ntot) were identified. The numbers were categorized into pN0, npos = 0; pN1, npos = [1,3]; pN2, npos = [4,9]; pN3, npos ≥ 10. The ratios npnx = npos/ntot were categorized into Lnr0, npnx = 0; Lnr1, npnx = (0,0.20]; Lnr2, npnx = (0.20,0.65]; Lnr3, npnx > 0.65. The GMD for pN-classification was 5.5 (standard error: ± 0.9) years, not much improved over a simple node-negative vs. node-positive that showed a GMD of 5.0 (± 1.4) years. The GMD for LNRc-classification was larger, 6.7 (± 0.8) years. Among other conventional metrics, Cox-model LNRc's c-index was 0.668 vs. pN's c = 0.641, indicating commensurate superiority of LNRc-classification. The usability of GMD-RMSTs warrants further investigation.

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Breast cancer preoperative 18FDG-PET, overall survival prognostic separation compared with the lymph node ratio

Cited by 6 publications

References 37 publications

Potential prognostic value of the lymph node ratio and its correlation with circulating sex hormone concentration in pathological T1/2 breast cancer patients: a retrospective study

Potential prognostic value of the lymph node ratio and its correlation with circulating sex hormone concentration in pathological T1/2 breast cancer patients: a retrospective study

Lymph Node Ratio after Neoadjuvant Chemotherapy for Stage II/III Breast Cancer: Prognostic Value Measured with Gini’s Mean Difference of Restricted Mean Survival Times

Gini's mean difference and the long-term prognostic value of nodal quanta classes after pre-operative chemotherapy in advanced breast cancer

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