The Impact of the Ratio of Positive Nodes to Removed Nodes on Recurrence and Overall Survival in Node Positive Breast Cancer Patients

Abstract

Purpose:The status of axillary lymph node (LN) metastasis is the most important prognostic factor in breast cancer. Postoperative regional nodal radiotherapy is recommended usually based on the number of metastatic LNs, which is associated with the total number of removed LNs during the axillary dissection. We evaluated the prognostic impact of the ratio of metastatic LNs to removed LNs on disease free survival and overall survival in breast cancer patients. Methods: The medical records of 743 breast cancer patients with metastatic axillary LNs and treated at Samsung Medical Center between 1994 and 2003 were retrospectively analyzed. The ratio of metastatic/removed LNs as well as the other prognostic factors were analyzed. Results: Both disease-free survival and overall survival rates were significantly worse in patients with a ratio of metastatic/ removed LNs greater than 20% compared to those patients with a ratio of less than 20% (p=0.028, p<0.001, respectively). In patients with T1-2 and N1 breast cancer, the ratio of metastatic/removed LNs greater than 20% was significantly associated with poorer disease-free survival (p=0.027). Conclusion:A ratio of metastatic/removed LNs greater than 20% in the axilla can be an adverse prognostic factor in breast cancer patients with axillary node metastasis. In T1-2 N1 breast cancer patients, adjuvant radiotherapy as well as more aggressive chemotherapy therapy may be indicated.

The Prognostic Significance of the Lymph Node Ratio in Axillary Lymph Node Positive Breast Cancer

“…Accurate staging information is very important for both patients and clinicians to assess the prognosis and to make informed decisions about breast cancer treatment. Our results are consistent with the findings of recent studies evaluating the relationship between LNR and survival for node positive breast cancer [ 4 - 10 ]. This study may be differentiated from other studies due to the subgroup analyses in each TNM stage and pN stage to evaluate the impact of the LNR.…”

“…However, there is no clear consensus about the cutoff points that are required for a staging classification. The cutoff points to classify patients into two groups are 0.2 [ 7 , 10 ] or 0.25 [ 8 ], which were most significant for recurrence or overall survival. Several authors divided patients into three groups using cutoffs such as 0.33/0.67 [ 11 ], 0.1/0.5 [ 4 ] or 0.25/0.5 [ 9 ].…”

Determining Which Patients Require Irradiation of the Supraclavicular Nodal Area After Surgery for N1 Breast Cancer

“…Involvement of more than 20% of the axillary nodes is a known prognostic factor associated with LRR (27,28). Significant prognostic factors for LRR include tumor size, number of involved axillary nodes, and presence of gross ECE.…”