Prognostic value of lymph node ratio in node-positive breast cancer in Egyptian patients

Elkhodary, Tawfik; Ebrahim, Mohamed A.; Hatata, Elsayed E.; Niazy, Nermeen A.

doi:10.1016/j.jnci.2013.10.001

Cited by 15 publications

(12 citation statements)

References 17 publications

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“…The value of positive lymph nodes ratio combined with negative lymph node count in prediction of breast cancer survival (8)(9)(10). Since total lymph nodes after axillary lymph node dissection (ALND) are composed of both positive and NLNs.…”

Section: Original Articlementioning

confidence: 99%

“…In fact, it is impossible that axillary dissection in every patient is of the same extent, so there must exist heterogeneity if we only use positive lymph node number to classify patients with different prognosis. To improve the efficiency of prognostic system in breast cancer, not only positive lymph node number, but also the number of total lymph nodes should be taken into account (8)(9)(10).…”

Section: Introductionmentioning

confidence: 99%

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The value of positive lymph nodes ratio combined with negative lymph node count in prediction of breast cancer survival

Yang

Long

et al. 2017

J. Thorac. Dis.

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Background: Positive lymph node ratio (LNR), defined as ratio of positive lymph nodes to all lymph nodes removed, is a powerful prognostic factor in invasive breast cancer. Here we focused on the impact of negative lymph node (NLN) count on the prediction of value of LNR in breast cancer survival.Methods: Of 929 invasive breast cancer patients were enrolled in our retrospective study. We use KaplanMeier to calculate the 5-year overall survival (OS) according to different clinicopathologic parameters. The prediction value of NLN count and LNR in OS was examined.Results: The optimal cutoff of NLN count was designated as 9. Five-year OS was 77.0% and 95.0% Conclusions: High NLN count is associated with improved survival in invasive breast cancer patients.Combining NLN count with LNR could be considered as an alternative to LNR alone in prediction of postoperative breast cancer survival.

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Section: Original Articlementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The value of positive lymph nodes ratio combined with negative lymph node count in prediction of breast cancer survival

Yang

Long

et al. 2017

J. Thorac. Dis.

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“…To our knowledge, the present report is the first to quantify the anatomic distribution of axillary nodes as well as to determine the metastatic burden by LNR at different levels. Such a ratio is considered to be superior for the measurement of metastatic burden (Vinh-Hung et al, 2009;Elkhodary et al, 2014). In our study, the number of nodes removed was optimal (> 10 nodes in all patients, with a mean value of 22.4 nodes).…”

Section: Discussionmentioning

confidence: 76%

“…All previous studies on axillary node metastases by levels were restricted to positive patients (Veronesi et al, 1987;Khafagy et al, 2011;Elkhodary et al, 2014). In the present report, we included patients with negative nodes.…”

Section: Discussionmentioning

confidence: 99%

The axillary lymph nodes in breast carcinoma

El-Bolkainy¹,

Badawy²,

Shawky³

et al. 2014

Egyptian Journal of Pathology

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Background and aim Axillary lymph node metastasis is the most important prognostic factors in breast carcinoma. The metastatic burden can be determined either by the number of lymph nodes with metastases (pN) or by the metastatic ratio (LNR), which is the ratio of positive nodes to the total nodes removed. The aim of the present investigation was to quantify the anatomic distribution of axillary lymph nodes by levels as well as to compare the metastatic burden of breast cancer at different nodal levels. A hypothetical model of incomplete lymphadenectomy was tested to determine the risk of such operations if performed in Egyptian patients. Patients and methods This study included 110 patients.In all operations, axillary dissection was complete including the three levels of nodes. The total series (110 patients) was used to study the anatomic distribution of axillary nodes at different levels as well as to study the rate of metastases at different levels. However, cases with positive nodes (56 patients) were used to determine the metastatic burden. ResultsThe total number of lymph nodes removed in the 110 cases was 2463 nodes. There were 1196 (48.6%) nodes at level I, 919 (37.3%) at level II, and 348 (14.1%) at level III (P < 0.001). The rate of lymph node metastases was 50.9%. The rates of node metastases at axillary levels I, II, and III were 50.9, 34.5, and 20%, respectively. The median number of metastatic lymph nodes in node-positive cases was 4, whereas the median numbers per level were 3, 4, and 3, respectively. The median lymph node ratio (LNR) for positive patients was 0.18, whereas the median LNRs per level were 0.3, 0.5, and 1, respectively (P < 0.001). Most of the node-positive patients (55.4%), according to LNR, were considered to be at low risk (r 0.2), whereas 28.6% were at an intermediate risk (0.2-0.65) and 16% were at a high risk (> 0.65%).Conclusion It can be concluded from this study that Egyptian patients with operable breast cancer present at a late stage (63.6% of tumors are >T1 and 50.9% have positive nodes). Anatomically, axillary nodes are commonly located (85.9%) at levels I and II and most metastases (86.8%) affect these two levels. However, level III is also involved in metastases in 20% of patients, hence the importance of a complete axillary lymphadenectomy in Egyptian patients.

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“…This has long been demonstrated as perhaps the most important prognostic indicator for disease free survival (Elkhodary et al, 2014;Wiznia et al, 2014;Singletary et al, 2002). More recently, the lymph node ratio (LNR; number of positive lymph nodes divided by the total examined) has been shown to be an alternative means of assessing risk of disease free survival, with some superiority when fewer than 10 lymph nodes are identified within the dissection specimen (Elkhodary et al, 2014;Wiznia et al, 2014;Chagpar, Camp, & Rimm, 2011). While our series did not meet the threshold for statistical significance for LNR association with disease control (p=0.052), this may have been due to the low number of cancer recurrence events.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Weight Change During and After Post-Operative Chemotherapy on Breast Cancer Control in Node-Positive Patients Treated With Trimodality Therapy

Johnson¹,

Lamb²,

Mills³

et al. 2014

CCO

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Objective: The purpose of this investigation was to determine whether an association exists between post-operative chemotherapy weight change and breast cancer control and survival, specifically within a high-risk population of women with node-positive breast cancer diagnosed and treated in the contemporary setting. Methods:A retrospective investigation with the following eligibility criteria: women who underwent primary surgical therapy for invasive breast cancer, were found to have pathologic evidence of nodal involvement, and were treated with adjuvant chemotherapy and radiation therapy. Demographic, tumor-, and treatment-related data were recorded and analyzed for association with disease control and survival outcomes. The post-operative/pre-chemotherapy weight and BMI served as the baseline comparator for future weight/BMI changes. Results:From January 2004 through December 2008, 52 patients were identified for inclusion. At a median follow-up of 77.2 months (range 19.9-119.4, with 85% followed >5 years), 8 patients experienced disease recurrence and 7 patients had died (3 with recurrent disease). Analysis of factors associated with study endpoints identified absolute weight and BMI change at 1, 3, and 4 years post-chemotherapy completion as significantly inversely associated with overall survival, but not associated with freedom from failure. Additionally, a statistically significant association between number of lymph nodes involved and freedom from failure was identified. Conclusion:This investigation did not detect statistically significant associations between weight or BMI change during chemotherapy and disease control or survival within this high-risk population, while the number of lymph nodes involved was directly related to risk of disease failure. Weight change at intervals following chemotherapy completion demonstrated some association with overall survival.

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Prognostic value of lymph node ratio in node-positive breast cancer in Egyptian patients

Cited by 15 publications

References 17 publications

The value of positive lymph nodes ratio combined with negative lymph node count in prediction of breast cancer survival

The value of positive lymph nodes ratio combined with negative lymph node count in prediction of breast cancer survival

The axillary lymph nodes in breast carcinoma

The Impact of Weight Change During and After Post-Operative Chemotherapy on Breast Cancer Control in Node-Positive Patients Treated With Trimodality Therapy

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