Ratio Between Positive Lymph Nodes and Total Excised Axillary Lymph Nodes as an Independent Prognostic Factor for Overall Survival in Patients with Nonmetastatic Lymph Node-Positive Breast Cancer

Abstract

Background. The status of the axillary lymph nodes in nonmetastatic lymph node-positive breast cancer (BC) patients remains the single most important determinant of overall survival (OS). Although the absolute number of nodes involved with cancer is important for prognosis, the role of the total number of excised nodes has received less emphasis. Thus, several studies have focused on the utility of the axillary lymph node ratio (ALNR) as an independent prognostic indicator of OS. However, most studies suffered from shortcomings, such as including patients who received neoadjuvant therapy or failing to consider the use of adjuvant therapy and tumor receptor status in their analysis. Methods. We conducted a single-center retrospective review of 669 patients with nonmetastatic lymph nodepositive BC. Data collected included patient demographics; breast cancer risk factors; tumor size, histopathological, receptor, and lymph node status; and treatment modalities used. Patients were subdivided into four groups according to ALNR value (\.25, .25-.49, .50-.74, .75-1.00). Study parameters were compared at the univariate and multivariate levels for their effect on OS.Results. On univariate analysis, both the absolute number of positive lymph nodes and the ALNR were significant predictors of OS. On multivariate analysis, only the ALNR remained an independent predictor of OS, with a 2.5-fold increased risk of dying at an ALNR of C.25. Conclusions. Our study demonstrates that ALNR is a stronger factor in predicting OS than the absolute number of positive axillary lymph nodes.Breast cancer (BC) is the most common cancer in women and the second most common cause of female cancer death, with an estimated 182,460 new cases diagnosed and 40,480 deaths in the United States in 2008. 1 Despite the advent of sentinel node biopsy techniques and the dawning of the molecular era of BC staging, the status of the axillary lymph nodes (ALN) remains the single most important determinant of overall survival (OS). [2][3][4][5][6] For patients with pathologically proven ALN involvement, the number of positive axillary lymph nodes (pALN) correlates with the incidence of distant metastasis and OS, and more than three pALN is associated with a 13% to 24% locoregional recurrence rate. 7,8 The relationship between number of pALN and survival seems to be linear, with each additional pALN detected leading to a worsening of the prognosis. 9,10 The American Joint Committee on Cancer staging system was recently revised, grouping patients by the absolute number of pALN. This classification improved stratification in OS, but the confounding effect that the number of excised nodes may have on the yield of positive nodes and its effect on BC-specific survival prognostic accuracy and management decisions are problems that remain unresolved. 6,11 Thus, the ratio between the number of pALN and the total number of excised nodes, or the axillary lymph node ratio (ALNR), may be a more comprehensive approach to estimate prognosis because it takes into accou...

Predictive Value of Pretreatment Peripheral Neutrophil-to-Lymphocyte Ratio for Response to Neoadjuvant Chemotherapy and Breast Cancer Prognosis

“…Numerous studies have indicated that lymph node ratio (LNR) has prognostic value in breast cancer. [23][24][25] As total lymph nodes by axillary lymph node dissection (ALND) is comprised of positive and negative lymph nodes, it is essential to bring the negative lymph node count into consideration for predicting breast cancer prognosis. We have found that a combination of the negative lymph node count with LNR could be a substitute for positive lymph node count alone in predicting postoperative breast cancer survival.…”