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Prognostic value of metastatic lymph node ratio in locally advanced breast cancer

Year 2022, , 1 - 8, 26.03.2022
https://doi.org/10.18663/tjcl.838615

Abstract

Aim: In this study we evaluated the prognostic value of the lymph node ratio. (LNR: defined as the number of involved nodes divided by the number of the nodes examined).
Patients and Methods: In this retrospective study, patients underwent axillary dissection due to breast cancer were examined. We evaluated 348 women underwent axillary dissection for nonmetastatic breast cancer in 9 Eylül University Hospital between 2006 and 2016. LNR were divided into three groups as low, intermediate and high risk (low, ≤0.20; intermediate, 0.21-0.65; high, > 0.65). Overall survival of the patients was estimated by the Kaplan Meier method for LNR. Overall relative mortality risks associated with LNR and pN were calculated by Cox regression.
Results: The mean survival was 95.1 months LNR high-risk group, while it was 100 months in N3 group. Even though it was not statistically significant, a lower survival rate of less than 5 months was observed in the LNR high group (P <0.74). High LNR associated with poor dissease specific survival rates with the mean 76.73 months of follow up. In the multivariate analysis, high LNR was an independent poor prognostic factor in breast cancer (LNR>0.65 HR 3.08; p=0.002).
Conclusion: LNR is highly significant in breast cancer and it provides more valuable information rather than TNM in terms of prognosis. Therefore, we think that, LNR can be used as a beneficial tool in breast cancer staging.

References

  • 1. World Health Organization International Agency for Research on Cancer. The Global Cancer Observatory. 2018 statistics. http://gco.iarc.fr/today /data/factsheets/populations/900-world-fact-sheets.pdf (Accessed on January 17, 2019).
  • 2. Fitzgibbons PL, Page DL, Weaver D, et al. Prognostic factors in breast cancer. College of American Pathologists Consensus Statement 1999. Arch Pathol Lab Med.2000;124: 966-78.
  • 3. Vinh-Hung V, Nguyen NP, Cserni G, et al. Prognostic value of nodal ratios in node-positive breast cancer: a compiled update. Future Oncol 2009; 5: 1585–603.
  • 4. Hatoum HA, Jamali FR, El-Saghir NS, et al. 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. Ann Surg Oncol 2009; 16: 3388–95.
  • 5. Woodward WA, Vinh-Hung V, Ueno NT, et al. Prognostic value of nodal ratios in node-positive breast cancer. J Clin Oncol 2006; 24: 2910–6.
  • 6. Vinh-Hung V, Verkooijen HM, Fioretta G, et al. Lymph noderatio as an alternative to pN staging in node-positive breast cancer. J Clin Oncol. 2009; 27: 1062–8.
  • 7. Peschaud F, Benoist S, Julie C, et al. The ratio of metastatic to examined lymph nodes is apowerful independent prognostic factor in rectal cancer. AnnSurg. 2008; 248: 1067–73.
  • 8. De Ridder M, Vinh-Hung V, Van Nieuwenhove Y, et al. Prognostic value of the lymph node ratioin node positive colon cancer. Gut.2006; 55: 1681.
  • 9. Peng J, Xu Y, Guan Z, et al. Prognosticsignificance of the metastatic lymph node ratio in node-positiverectal cancer. Ann Surg Oncol. 2008;15: 3118–23.
  • 10. Chagpar AB, Camp RL, Rimm DL. Lymph node ratio should be considered for incorporation into staging for breast cancer. Ann Surg Oncol. 2011; 18: 3143–8.
  • 11. Amin MB, Edge FL, Edge SB, et al. The eighth edition AJCC Cancer Staging Manual: continuing to build a bridge from a population‐based to a more “personalized” approach to cancer staging. CA Cancer J Clin. 2017; 67: 93‐99.
  • 12. Walker MJ, Osborne MD, Young DC, et al. The natural history of breast cancer with more than 10 positive nodes. Am J Surg 1995; 169: 575-9.
  • 13. Overgaard M, Hansen PS, Overgaard J, et al. Postoperative radiotherapy in high-risk premenopausal women with breast cancer who receive adjuvant chemotherapy: Danish Breast Cancer Cooperative Group 82b Trial. N Engl J Med 1997; 337: 949955.
  • 14. Grills IS, Kestin LL, Goldstein N, et al. Risk factors for regional nodal failure after breastconserving therapy: Regional nodal irradiation reduces rate of axillary failure in patients with four or more positive lymph nodes. Int J Radiat Oncol Biol Phys 2003; 56: 658-70.
  • 15. Knoop AS, Bentzen SM, Nielsen MM, et al. Value of epidermal growth factor receptor, HER2, p53, and steroid receptors in predicting the efficacy of tamoxifen in high-risk postmenopausal breast cancer patients. J Clin Oncol 2001; 19: 3376-84.
  • 16. .Gurkaynak M, Yildiz F, Atahan IL: T3N0M0 Breast cancer patients: A subgroup with favorable prognosis. Turk J Cancer 2003; 33: 144-9.
  • 17. Tsuchiya A, Kanno M, Abe R.The impact of lymph node metastases on the survival of breast cancer patients with ten or more positive lymph nodes. Surg Today 1997; 27: 902-6.
  • 18. Walker MJ, Osborne MD, Young DC, et al. The natural history of breast cancer with more than 10 positive nodes. Am J Surg 1995; 169: 575-9.
  • 19. Overgaard M, Hansen PS, Overgaard J, et al. Postoperative radiotherapy in high-risk premenopausal women with breast cancer who receive adjuvant chemotherapy: Danish Breast Cancer Cooperative Group 82b Trial. N Engl J Med 1997; 337: 949955.
  • 20. Grills IS, Kestin LL, Goldstein N, et al. Risk factors for regional nodal failure after breastconserving therapy: Regional nodal irradiation reduces rate of axillary failure in patients with four or more positive lymph nodes. Int J Radiat Oncol Biol Phys 2003; 56: 658-70.
  • 21. Knoop AS, Bentzen SM, Nielsen MM, et al. Value of epidermal growth factor receptor, HER2, p53, and steroid receptors in predicting the efficacy of tamoxifen in high-risk postmenopausal breast cancer patients. J Clin Oncol 2001; 19: 3376-84.
  • 22. Vinh-Hung V, Verkooijen HM, Fioretta G, et al. Lymph node ratio as an alternative to pN staging in node-positive breast cancer. J Clin Oncol. 2009; 27: 1062–8.
  • 23. Schaapveld M, de Vries EG, van der Graaf WT, et al. The prognostic effect of the number of histologically examined axillary lymph nodes in breast cancer: stage migration or age association? Ann Surg Oncol. 2006; 13: 465–74.
  • 24. Kiricuta CI, Tausch J. A mathematical model of axillary lymph node involvement based on 1446 complete axillary dissections in patients with breast carcinoma. Cancer. 1992; 69: 2496–501.

Lokal ileri meme kanserinde metastatik lenf nodu oranının prognostik değeri

Year 2022, , 1 - 8, 26.03.2022
https://doi.org/10.18663/tjcl.838615

Abstract

Öz
Amaç: Bu çalışmada, lenf nodu oranının prognostik önemini değerlendirdik (LNR: metastatik lenf nodlarının toplam disseke edilen lenf nodlarına oranı).
Gereç ve Yöntemler: Bu retrospektif çalışmada meme kanseri nedeniyle koltuk altı diseksiyonu yapılan hastalar incelendi. 2006-2016 yılları arasında 9 Eylül Üniversitesi Hastanesi'nde metastatik olmayan meme kanseri nedeniyle koltuk altı diseksiyonu yapılan 348 kadını değerlendirdik. LNR düşük, orta ve yüksek riskli (düşük, ≤0.20; orta, 0.21-0.65; yüksek> 0.65) olarak üç gruba ayrıldı. Hastaların genel sağkalımı, LNR için Kaplan Meier yöntemi ile tahmin edildi. LNR ve pN ile ilişkili genel bağıl ölüm riskleri Cox regresyonu ile hesaplandı.
Bulgular: Ortalama talip süresi 76.73 ay olarak bulundu. Ortalama sağkalım LNR yüksek riskli grupta 95.1 ay iken, N3 grubunda 100 aydı. İstatistiksel olarak anlamlı olmamakla birlikte, LNR yüksek grupta 5 aydan daha düşük sağkalım oranı gözlendi (P <0.74). Çok değişkenli analizde, yüksek LNR, meme kanserinde bağımsız bir kötü prognostik faktördü (LNR> 0.65 HR 3.08; p = 0.002).
Sonuç: LNR meme kanserinde oldukça önemlidir ve prognoz açısından TNM'den çok daha değerli bilgiler sağlar. Bu nedenle LNR'nin meme kanseri evrelemesinde faydalı bir araç olarak kullanılabileceğini düşünüyoruz.

References

  • 1. World Health Organization International Agency for Research on Cancer. The Global Cancer Observatory. 2018 statistics. http://gco.iarc.fr/today /data/factsheets/populations/900-world-fact-sheets.pdf (Accessed on January 17, 2019).
  • 2. Fitzgibbons PL, Page DL, Weaver D, et al. Prognostic factors in breast cancer. College of American Pathologists Consensus Statement 1999. Arch Pathol Lab Med.2000;124: 966-78.
  • 3. Vinh-Hung V, Nguyen NP, Cserni G, et al. Prognostic value of nodal ratios in node-positive breast cancer: a compiled update. Future Oncol 2009; 5: 1585–603.
  • 4. Hatoum HA, Jamali FR, El-Saghir NS, et al. 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. Ann Surg Oncol 2009; 16: 3388–95.
  • 5. Woodward WA, Vinh-Hung V, Ueno NT, et al. Prognostic value of nodal ratios in node-positive breast cancer. J Clin Oncol 2006; 24: 2910–6.
  • 6. Vinh-Hung V, Verkooijen HM, Fioretta G, et al. Lymph noderatio as an alternative to pN staging in node-positive breast cancer. J Clin Oncol. 2009; 27: 1062–8.
  • 7. Peschaud F, Benoist S, Julie C, et al. The ratio of metastatic to examined lymph nodes is apowerful independent prognostic factor in rectal cancer. AnnSurg. 2008; 248: 1067–73.
  • 8. De Ridder M, Vinh-Hung V, Van Nieuwenhove Y, et al. Prognostic value of the lymph node ratioin node positive colon cancer. Gut.2006; 55: 1681.
  • 9. Peng J, Xu Y, Guan Z, et al. Prognosticsignificance of the metastatic lymph node ratio in node-positiverectal cancer. Ann Surg Oncol. 2008;15: 3118–23.
  • 10. Chagpar AB, Camp RL, Rimm DL. Lymph node ratio should be considered for incorporation into staging for breast cancer. Ann Surg Oncol. 2011; 18: 3143–8.
  • 11. Amin MB, Edge FL, Edge SB, et al. The eighth edition AJCC Cancer Staging Manual: continuing to build a bridge from a population‐based to a more “personalized” approach to cancer staging. CA Cancer J Clin. 2017; 67: 93‐99.
  • 12. Walker MJ, Osborne MD, Young DC, et al. The natural history of breast cancer with more than 10 positive nodes. Am J Surg 1995; 169: 575-9.
  • 13. Overgaard M, Hansen PS, Overgaard J, et al. Postoperative radiotherapy in high-risk premenopausal women with breast cancer who receive adjuvant chemotherapy: Danish Breast Cancer Cooperative Group 82b Trial. N Engl J Med 1997; 337: 949955.
  • 14. Grills IS, Kestin LL, Goldstein N, et al. Risk factors for regional nodal failure after breastconserving therapy: Regional nodal irradiation reduces rate of axillary failure in patients with four or more positive lymph nodes. Int J Radiat Oncol Biol Phys 2003; 56: 658-70.
  • 15. Knoop AS, Bentzen SM, Nielsen MM, et al. Value of epidermal growth factor receptor, HER2, p53, and steroid receptors in predicting the efficacy of tamoxifen in high-risk postmenopausal breast cancer patients. J Clin Oncol 2001; 19: 3376-84.
  • 16. .Gurkaynak M, Yildiz F, Atahan IL: T3N0M0 Breast cancer patients: A subgroup with favorable prognosis. Turk J Cancer 2003; 33: 144-9.
  • 17. Tsuchiya A, Kanno M, Abe R.The impact of lymph node metastases on the survival of breast cancer patients with ten or more positive lymph nodes. Surg Today 1997; 27: 902-6.
  • 18. Walker MJ, Osborne MD, Young DC, et al. The natural history of breast cancer with more than 10 positive nodes. Am J Surg 1995; 169: 575-9.
  • 19. Overgaard M, Hansen PS, Overgaard J, et al. Postoperative radiotherapy in high-risk premenopausal women with breast cancer who receive adjuvant chemotherapy: Danish Breast Cancer Cooperative Group 82b Trial. N Engl J Med 1997; 337: 949955.
  • 20. Grills IS, Kestin LL, Goldstein N, et al. Risk factors for regional nodal failure after breastconserving therapy: Regional nodal irradiation reduces rate of axillary failure in patients with four or more positive lymph nodes. Int J Radiat Oncol Biol Phys 2003; 56: 658-70.
  • 21. Knoop AS, Bentzen SM, Nielsen MM, et al. Value of epidermal growth factor receptor, HER2, p53, and steroid receptors in predicting the efficacy of tamoxifen in high-risk postmenopausal breast cancer patients. J Clin Oncol 2001; 19: 3376-84.
  • 22. Vinh-Hung V, Verkooijen HM, Fioretta G, et al. Lymph node ratio as an alternative to pN staging in node-positive breast cancer. J Clin Oncol. 2009; 27: 1062–8.
  • 23. Schaapveld M, de Vries EG, van der Graaf WT, et al. The prognostic effect of the number of histologically examined axillary lymph nodes in breast cancer: stage migration or age association? Ann Surg Oncol. 2006; 13: 465–74.
  • 24. Kiricuta CI, Tausch J. A mathematical model of axillary lymph node involvement based on 1446 complete axillary dissections in patients with breast carcinoma. Cancer. 1992; 69: 2496–501.
There are 24 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Orıgınal Artıcle
Authors

Sami Benli

Suleyman Aksoy 0000-0003-2217-6819

Mehmet Serdar Saydam 0000-0002-4024-892X

Merih Durak 0000-0003-3516-952X

Publication Date March 26, 2022
Published in Issue Year 2022

Cite

APA Benli, S., Aksoy, S., Saydam, M. S., Durak, M. (2022). Prognostic value of metastatic lymph node ratio in locally advanced breast cancer. Turkish Journal of Clinics and Laboratory, 13(1), 1-8. https://doi.org/10.18663/tjcl.838615
AMA Benli S, Aksoy S, Saydam MS, Durak M. Prognostic value of metastatic lymph node ratio in locally advanced breast cancer. TJCL. March 2022;13(1):1-8. doi:10.18663/tjcl.838615
Chicago Benli, Sami, Suleyman Aksoy, Mehmet Serdar Saydam, and Merih Durak. “Prognostic Value of Metastatic Lymph Node Ratio in Locally Advanced Breast Cancer”. Turkish Journal of Clinics and Laboratory 13, no. 1 (March 2022): 1-8. https://doi.org/10.18663/tjcl.838615.
EndNote Benli S, Aksoy S, Saydam MS, Durak M (March 1, 2022) Prognostic value of metastatic lymph node ratio in locally advanced breast cancer. Turkish Journal of Clinics and Laboratory 13 1 1–8.
IEEE S. Benli, S. Aksoy, M. S. Saydam, and M. Durak, “Prognostic value of metastatic lymph node ratio in locally advanced breast cancer”, TJCL, vol. 13, no. 1, pp. 1–8, 2022, doi: 10.18663/tjcl.838615.
ISNAD Benli, Sami et al. “Prognostic Value of Metastatic Lymph Node Ratio in Locally Advanced Breast Cancer”. Turkish Journal of Clinics and Laboratory 13/1 (March 2022), 1-8. https://doi.org/10.18663/tjcl.838615.
JAMA Benli S, Aksoy S, Saydam MS, Durak M. Prognostic value of metastatic lymph node ratio in locally advanced breast cancer. TJCL. 2022;13:1–8.
MLA Benli, Sami et al. “Prognostic Value of Metastatic Lymph Node Ratio in Locally Advanced Breast Cancer”. Turkish Journal of Clinics and Laboratory, vol. 13, no. 1, 2022, pp. 1-8, doi:10.18663/tjcl.838615.
Vancouver Benli S, Aksoy S, Saydam MS, Durak M. Prognostic value of metastatic lymph node ratio in locally advanced breast cancer. TJCL. 2022;13(1):1-8.


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