Journal List > J Breast Cancer > v.11(4) > 1036112

Kim, Lim, Lee, Choi, Kim, Choe, Kim, Kim, Lee, Nam, and Yang: 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.

Figures and Tables

Fig 1
Disease-free survival and overall survival by the ratio of metastatic/removed axillary lymph nodes with the cut-off value of 20% in the breast cancer patients with positive axillary lymph node(s) (n=743).
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Fig 2
Disease-free survival and overall survival by the ratio of metastatic/removed axillary lymph nodes with the cut-off value of 20% in the patients with T1-2 and N1 breast cancer (n=387).
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Table 1
Characteristics of patients (n=743)
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LN=lymph node.

Table 2
Univariate analysis of DFS and OS by prognostic factors, for patients with axillary LN(+) (n=743)
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DFS=disease free survival; OS=overall survival; LN=lymph node; LVI=lymphovascular invasion.

Table 3
Multivariate analysis of DFS and OS by prognostic factors, for patients with axillary LN(+) (n=743)
jbc-11-194-i003

DFS=disease free survival; OS=overall survival; LN=lymph node; CI=confidence interval; LVI=lymphovascular invasion.

Table 4
Multivariate analysis of DFS and OS by prognostic factors, for patients with T1 or 2 and N1 stage (n=387)
jbc-11-194-i004

DFS=disease free survival; OS=overall survival; CI=confidence interval; LVI=lymphovascular invasion; LN=lymph node.

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