Prognostic Value of Nodal Ratios in Node-Positive Breast Cancer

Woodward, Wendy A.; Vinh-Hung, Vincent; Ueno, Naoto T.; Cheng, Yee Chung; Royce, Melanie; Tai, Patricia; Vlastos, Georges; Wallace, Anne M.; Hortobágyi, Gabriel N.; Nieto, Yago

doi:10.1200/jco.2005.03.1526

Cited by 182 publications

(155 citation statements)

References 37 publications

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“…On the contrary, in the experience reported by Insa et al [9], either tumour size or number of lymph nodes involved at diagnosis had independent prognostic significance. In the Alamo database, lymph node involvement, considered as nodal ratio (absolute number of involved nodes-number of nodes resected [14]), turned out to be a relevant prognostic factor in breast cancer patients with distant metastasis. As a result, for patients with \0.25 ratio median survival was 2.31 years, versus 1.78 years for those whose ratio was between 0.25 and 0.75, and 1.25 for ratios [0.75.…”

Section: Discussionmentioning

confidence: 99%

Practical prognostic index for patients with metastatic recurrent breast cancer: retrospective analysis of 2,322 patients from the GEICAM Spanish El Alamo Register

Puente

López-Tarruella

Ruı́z

et al. 2010

Breast Cancer Res Treat

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International audienceWomen with recurrent metastatic breast cancer from a Spanish hospital registry (El Alamo, GEICAM) were analyzed in order to identify the most helpful prognostic factors to predict survival and to ultimately construct a practical prognostic index. The inclusion criteria covered women patients diagnosed with operable invasive breast cancer who had metastatic recurrence between 1990 and 1997 in GEICAM hospitals. Patients with stage IV breast cancer at initial diagnosis or with isolated loco-regional recurrence were excluded from this analysis. Data from 2,322 patients with recurrent breast cancer after primary treatment (surgery, radiation and systemic adjuvant treatment) were used to construct the prognostic index. The prognostic index score for each individual patient was calculated by totalling up the scores of each independent variable. The maximum score obtainable was 26.1. Nine-hundred and sixty-two patients who had complete data for all the variables were used in the computation of the prognostic index score. We were able to stratify them into three prognostic groups based on the prognostic index score: 322 patients in the good risk group (score ≤13.5), 308 patients in the intermediate risk group (score 13.51–15.60) and 332 patients in the poor risk group (score ≥15.61). The median survivals for these groups were 3.69, 2.27 and 1.02 years, respectively ( < 0.0001). In conclusion, risk scores are extraordinarily valuable tools, highly recommendable in the clinical practice

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Section: Discussionmentioning

confidence: 99%

Practical prognostic index for patients with metastatic recurrent breast cancer: retrospective analysis of 2,322 patients from the GEICAM Spanish El Alamo Register

Puente

López-Tarruella

Ruı́z

et al. 2010

Breast Cancer Res Treat

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“…In breast cancer, the nodal ratio has been shown to be an important predictor of loco-regional recurrence and survival both from initial diagnosis and following recurrence (Nieto et al, 2002;Grills et al, 2003;Woodward et al, 2006). Several studies compared the prognostic value of nodal ratios to the absolute number of positive nodes and found that lymph node ratio had a stronger prognostic value in breast cancer (Vinh-Hung et al, 2004;Woodward et al, 2006). Small retrospective studies from single institutions have evaluated the significance of the absolute number and ratio of positive nodes in uterine cancers.…”

Section: Discussionmentioning

confidence: 99%

The impact of the absolute number and ratio of positive lymph nodes on survival of endometrioid uterine cancer patients

et al. 2007

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The aim of the study was to determine the impact of the absolute number and ratio of positive lymph nodes on the survival in nodepositive endometrioid uterine cancer. Data were obtained from the National Cancer Institute Registry from 1988 to 2001. Analyses were performed using Kaplan -Meier and Cox proportional hazard methods. A total of 1222 women were diagnosed with stage IIIC-IV node-positive endometrioid corpus cancer. The 5-year disease-specific survival of women with 1, 2 -5, and 45 positive nodes were 68.1, 55.1, and 46.1%, respectively (Po0.001). Increasing lymph node ratio, expressed as a percentage of positive nodes to total nodes identified (p10, 410 -p50, and 450%), was associated with a decrease in survival from 77.3 to 60.7 to 40.9%, respectively (Po0.001). The absolute number of positive nodes and the lymph node ratio remained significant after adjusting for stage (IIIC vs IV) and the extent of lymphadenectomy (p20 vs 420 nodes). On multivariate analysis, the absolute number of positive nodes and lymph node ratio were significant independent prognostic factors for survival. Increasing absolute number of positive nodes and lymph node ratio are associated with a poorer survival in women with node-positive uterine cancers. The stratification of nodepositive uterine cancer for prognostic and treatment purposes warrants further investigation.

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“…[1][2][3] However, the risk that screendetected cancer can lead to overdiagnosis in up to 24% of the cases, has been recently suggested. 4,5 Moreover, the introduction of the sentinel node procedure [6][7][8] has led to an increase in the detection rate of small lymph node metastases, due to more accurate pathological assessment that include step sectioning 9,10 and immunohistochemistry. 11 Finally, the new drugs and an enhanced tuning of already existing therapeutic approaches have contributed to a better disease control.…”

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confidence: 99%

Tumor size, node status, grading, HER2 and estrogen receptor status still retain a strong value in patients with operable breast cancer diagnosed in recent years

Cortesi

Marcheselli

Guarneri

et al. 2012

Intl Journal of Cancer

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Breast cancer prognosis has improved greatly in recent years. Consequently, a thorough search for sensitive prognostic factors, able to help clinicians offer appropriate therapy, has become a priority in this area. In this study, we considered all new cases of invasive breast cancer diagnosed in the Province of Modena, Italy, between 1997 and, registered by the Modena Cancer Registry. The principal endpoint of this study was relapse-free survival (RFS). A set of 11 clinic and pathological parameters was investigated. After a median follow-up of 73 months, 494 relapses were recorded. Tumor size, node status, grading, HER2 and estrogen receptor status were retained as independent factors in a multivariate analysis. Using these variables, a prognostic model was devised to identify three groups at different risk. In the training sample, the 5-year RFS rates resulted 96.0%, 82.9% and 63.7% in patients at low, intermediate and high risk, respectively (p < 0.0001). In the validation sample, the 5-year RFS was 96.2%, 85.4% and 66.9%, respectively. To conclude our study demonstrates that a very simple prognostic index based on easily available clinical data may represent a useful tool for the identification of patients at different risk of relapse and may be a notable device to predict who truly benefits from medical treatment.The adoption of wide-scale mammographic screening for the detection of breast cancer at an earlier phase of development has resulted in an increasing number of cases being diagnosed at a very early stage, together with a reduction in breast cancer morbidity and mortality.1-3 However, the risk that screendetected cancer can lead to overdiagnosis in up to 24% of the cases, has been recently suggested. 4,5 Moreover, the introduction of the sentinel node procedure 6-8 has led to an increase in the detection rate of small lymph node metastases, due to more accurate pathological assessment that include step sectioning 9,10 and immunohistochemistry. 11 Finally, the new drugs and an enhanced tuning of already existing therapeutic approaches have contributed to a better disease control.Consequently, a thorough search for more sensitive prognostic factors, able to help clinicians offer appropriate adjuvant therapy after surgery, balancing the benefits of the prevention of recurrence and the risks related with unnecessary treatment, has become a priority in this area.In the past, the recognition of prognostic factors was based on the retrospective analysis of archive data and results were limited by patient selection criteria, missing data, no inclusion of more recently reported parameters and outdated adjuvant therapies. Finally, although overall survival (OS) should be the optimal endpoint, in a disease with an increasing scarcity of events, it appears unrealistic and requires a very long follow-up period.For all these reasons, we collected an exhaustive set of clinical, laboratory, pathological and therapeutic information for all cases of breast cancer diagnosed in the Province of Modena, Northern Italy, w...

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Prognostic Value of Nodal Ratios in Node-Positive Breast Cancer

Cited by 182 publications

References 37 publications

Practical prognostic index for patients with metastatic recurrent breast cancer: retrospective analysis of 2,322 patients from the GEICAM Spanish El Alamo Register

Practical prognostic index for patients with metastatic recurrent breast cancer: retrospective analysis of 2,322 patients from the GEICAM Spanish El Alamo Register

The impact of the absolute number and ratio of positive lymph nodes on survival of endometrioid uterine cancer patients

Tumor size, node status, grading, HER2 and estrogen receptor status still retain a strong value in patients with operable breast cancer diagnosed in recent years

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