Clinical relevance of lymph node ratio in breast cancer patients with one to three positive lymph nodes

S. I. Kim, S. H. Cho, J. S. Lee, H. G. Moon, W. C. Noh, H. J. Youn, B. K. Ko, B. W. Park

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Background:To test the hypotheses that breast cancer patients with one to three positive lymph nodes (pN1) consist of heterogeneous prognostic subsets and that the ratio of positive nodes to total nodes dissected (lymph node ratio, LNR) might discriminate patients with a higher risk as candidates for post-mastectomy radiation therapy (PMRT).Methods:Using information from 7741 node-positive patients, we first identified cutoff values of the LNR using the nonparametric bootstrap method. Focusing on 3477 patients with pN1 disease, we then evaluated the clinical relevance of the LNR categorised by the estimated cutoff values (categorised LNR, cLNR).Results:Among 3477 patients with pN1 disease, 3059 and 418 patients were assigned into the low and intermediate cLNR groups, respectively, based on a cutoff value of 0.18. The prognostic factors associated with poor overall survival (OS) included younger age, T2 stage, negative oestrogen/progesterone receptors, high histologic grade, and intermediate cLNR. Post-mastectomy radiation therapy significantly increased OS in patients assigned to the intermediate cLNR (hazard ratio, 0.39; 95% confidence interval, 0.17-0.89; P=0.0248), whereas patients in the low cLNR group derived no additional survival benefit from PMRT.Conclusion:This study suggests that PMRT should be recommended for patients with pN1 disease and an intermediate cLNR.

Original languageEnglish
Pages (from-to)1165-1171
Number of pages7
JournalBritish journal of cancer
Volume109
Issue number5
DOIs
Publication statusPublished - 2013 Sep 1

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Lymph Nodes
Breast Neoplasms
Mastectomy
Radiotherapy
Survival
Progesterone Receptors
Estrogen Receptors
Confidence Intervals

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

Cite this

Kim, S. I. ; Cho, S. H. ; Lee, J. S. ; Moon, H. G. ; Noh, W. C. ; Youn, H. J. ; Ko, B. K. ; Park, B. W. / Clinical relevance of lymph node ratio in breast cancer patients with one to three positive lymph nodes. In: British journal of cancer. 2013 ; Vol. 109, No. 5. pp. 1165-1171.
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Clinical relevance of lymph node ratio in breast cancer patients with one to three positive lymph nodes. / Kim, S. I.; Cho, S. H.; Lee, J. S.; Moon, H. G.; Noh, W. C.; Youn, H. J.; Ko, B. K.; Park, B. W.

In: British journal of cancer, Vol. 109, No. 5, 01.09.2013, p. 1165-1171.

Research output: Contribution to journalArticle

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T1 - Clinical relevance of lymph node ratio in breast cancer patients with one to three positive lymph nodes

AU - Kim, S. I.

AU - Cho, S. H.

AU - Lee, J. S.

AU - Moon, H. G.

AU - Noh, W. C.

AU - Youn, H. J.

AU - Ko, B. K.

AU - Park, B. W.

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N2 - Background:To test the hypotheses that breast cancer patients with one to three positive lymph nodes (pN1) consist of heterogeneous prognostic subsets and that the ratio of positive nodes to total nodes dissected (lymph node ratio, LNR) might discriminate patients with a higher risk as candidates for post-mastectomy radiation therapy (PMRT).Methods:Using information from 7741 node-positive patients, we first identified cutoff values of the LNR using the nonparametric bootstrap method. Focusing on 3477 patients with pN1 disease, we then evaluated the clinical relevance of the LNR categorised by the estimated cutoff values (categorised LNR, cLNR).Results:Among 3477 patients with pN1 disease, 3059 and 418 patients were assigned into the low and intermediate cLNR groups, respectively, based on a cutoff value of 0.18. The prognostic factors associated with poor overall survival (OS) included younger age, T2 stage, negative oestrogen/progesterone receptors, high histologic grade, and intermediate cLNR. Post-mastectomy radiation therapy significantly increased OS in patients assigned to the intermediate cLNR (hazard ratio, 0.39; 95% confidence interval, 0.17-0.89; P=0.0248), whereas patients in the low cLNR group derived no additional survival benefit from PMRT.Conclusion:This study suggests that PMRT should be recommended for patients with pN1 disease and an intermediate cLNR.

AB - Background:To test the hypotheses that breast cancer patients with one to three positive lymph nodes (pN1) consist of heterogeneous prognostic subsets and that the ratio of positive nodes to total nodes dissected (lymph node ratio, LNR) might discriminate patients with a higher risk as candidates for post-mastectomy radiation therapy (PMRT).Methods:Using information from 7741 node-positive patients, we first identified cutoff values of the LNR using the nonparametric bootstrap method. Focusing on 3477 patients with pN1 disease, we then evaluated the clinical relevance of the LNR categorised by the estimated cutoff values (categorised LNR, cLNR).Results:Among 3477 patients with pN1 disease, 3059 and 418 patients were assigned into the low and intermediate cLNR groups, respectively, based on a cutoff value of 0.18. The prognostic factors associated with poor overall survival (OS) included younger age, T2 stage, negative oestrogen/progesterone receptors, high histologic grade, and intermediate cLNR. Post-mastectomy radiation therapy significantly increased OS in patients assigned to the intermediate cLNR (hazard ratio, 0.39; 95% confidence interval, 0.17-0.89; P=0.0248), whereas patients in the low cLNR group derived no additional survival benefit from PMRT.Conclusion:This study suggests that PMRT should be recommended for patients with pN1 disease and an intermediate cLNR.

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