Prognostic Value of Lymph Node Ratio in Breast Cancer Patients with Adequate Pathologic Evidence After Neoadjuvant Chemotherapy

Abstract

Departmental sources Background:The prognostic role of axillary lymph node ratio (LNR) after neoadjuvant chemotherapy (NAC) in breast cancer has not been illuminated. This study was designed to investigate the prognostic role of LNR in breast cancer compared with traditional ypN stage. Material/Methods:A total of 306 breast cancer patients diagnosed with positive axillary lymph nodes from January 2007 to December 2014 were eligible for this retrospective analysis. All enrolled patients were treated with a median of 4 cycles of NAC followed by mastectomy and level I, II, and III axillary lymph node dissection (ALND). Results:The median duration of follow-up was 78 months (range, 7-147 months). Univariate analysis indicated that both the LNR category (P<0.001) and ypN stage (P<0.001) were significant associated with event-free survival (EFS) and overall survival (OS). However, multivariate analysis indicated that the LNR category was independently associated with EFS (P<0.001) and OS (P<0.001), while the ypN stage showed no statistical effect on EFS (P=0.391) or OS (P=0.081). On additional analyses stratified by molecular subtypes, we found that the prognosis of triple negative breast cancer could be better discriminated when the cutoff value of LNR was set at 0.15. Conclusions:LNR showed a superior predictive value in evaluating prognosis of breast cancer patients after NAC. In addition, the LNR cutoff point 0.15 can accurately discriminate survival outcomes for different triple negative breast cancer subtypes.

Eribulin-based neoadjuvant chemotherapy for triple-negative breast cancer patients stratified by homologous recombination deficiency status: a multicenter randomized phase II clinical trial

“…A more objective measure than BCSR for evaluating neoadjuvant therapy is the proportion of patients whose lymph node status changes from positive to negative. Changes in lymph node status reflect the efficacy of a chemotherapeutic regimen and can greatly influence prognosis [47]. In the present study, the likelihood of negative lymph node status being achieved by the time of surgery was similar between the regimens in each of groups A and B.…”

The prognostic role of lymph node ratio in breast cancer patients received neoadjuvant chemotherapy: A dose-response meta-analysis

“…Of the 12 studies, 10 studies reported OS and 11 reported DFS. With regard to the study area, four studies were conducted in Chinese ( 10 , 19 , 22 , 27 ), while the remaining nine studies were conducted in non-Chinese countries. The median follow-up ranged from 24 to 87 months.…”

“…Moreover, 11 studies ( 9 , 10 , 18 – 22 , 24 – 27 ) examined the association between higher LNR and shorter OS of breast cancer patients after neoadjuvant chemotherapy. The results showed a significant association (HR: 4.77; 95%CI: 3.69–6.17; P < 0.001) with no heterogeneity ( I 2 = 41.6%; P = 0.072) ( Figure 2B ).…”

“…After the exclusion of duplicate studies and non-relevant studies based on a screening of article titles and abstracts, 38 potentially relevant studies were retrieved for full review. According to the pre-established inclusion and exclusion criteria, 13 studies, involving 4,864 breast cancer patients, were included in this study (9)(10)(11)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27). The flow diagram of the literature search was shown in Figure 1.…”

“…Liu D et al ( 8 ) proved that LNR is a prognostic factor for breast cancer in a meta-analysis, but the study did not conduct a subgroup analysis of patients received neoadjuvant chemotherapy, and the accuracy of LNR in evaluating the prognosis of patients received neoadjuvant chemotherapy is not clear. Some studies showed that LNR has important value in predicting the prognosis of breast cancer patients receiving neoadjuvant chemotherapy and its prognostic value was greater than that of current N staging ( 9 , 10 ). However, Saxena et al ( 11 ) found that LNR was an independent prognostic factor of breast cancer after neoadjuvant chemotherapy, and its prognostic value was poorer than that of ypN stage.…”