Lymph Node Ratio is More Valuable than Level III Involvement for Prediction of Outcome in Node-Positive Breast Carcinoma Patients
We examined the relationship between different expressions of positive axillary lymph nodes (PN) and the outcomes of node-positive breast carcinoma patients to determine the best predictor(s) among these expressions and to assess whether anatomic high level involvement is an independent prognostic factor.
In this retrospective study, the primary endpoints were distant recurrence (DR), locoregional recurrences (LRR), and disease-free survival (DFS). Univariate and multivariate prognostic factor analyses were carried out using survival and regression methods in the data of 704 patients with PN.
In multivariate analysis, the number of PN, ratio of PN, log odds of PN, and level III (L-III) involvement, separately, were significant factors for DR in addition to age, tumor size, and lymphovascular invasion (LVI). In the final model including all expressions of nodal involvement, age (continuous P = 0.001; hazard ratio [HR]: 0.98; 95% confidence Interval [95% CI]: 0.96–0.99), tumor size (continuous: P < 0.0001; HR: 1.3; 95% CI, 1.2–1.5), LVI (yes vs. no: P = 0.005; HR: 1.6; 95% CI, 1.2–2.2), and ratio of PN (continuous: P = 0.02; HR: 1.03; 95% CI, 1.01–1.06) were the independent prognostic factors for DR. For LRR, ratio of PN (continuous: P = 0.001; HR: 1.02; 95% CI, 1.01–1.03) was the most important factor in addition to age (continuous: P = 0.02; HR: 0.98; 95% CI, 0.97–0.99) and tumor size (continuous: P = 0.04; HR: 1.3; 95% CI, 1.1–1.6). When patients were stratified by number categories of PN (1–3 vs. 4–9 vs. ≥ 10), there was no difference between DFSs of patients with and without L-III involvement. In contrast, when patients were stratified by L-III involvement, DFSs according to the number categories were statistically different.
Ratio of PN was more valuable than number of PN for predicting outcome in node-positive breast carcinoma patients. Level III involvement was not an independent prognostic indicator either for locoregional or for distant recurrences.
- 12.Greene FL, Page DL, Fleming ID, et al. editors. AJCC Cancer Staging Manuel. 6th ed. Berlin Heidelberg New York: Springer, 2002Google Scholar
- 16.Cox DR. Regression models and life tables. J R Stat Soc 1972;B34:187–220Google Scholar
- 17.Kleinbaum DG, Kupper LL, Muller KE, et al. editors. Applied Regression Analysis and Other Multivariable Methods, 3rd edn. Pacific Grove: Brooks/Cole, 1998Google Scholar
- 18.Harrell FE Jr. Regression Modeling Strategies with Applications to Linear Models, Logistic Regression, and Survival Analysis. Berlin Heidelberg New York: Springer, 2001Google Scholar
- 63.Early Breast Cancer Trialists’ Collaborative Group (EBCTCG). Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet 2005;366:2087–2106Google Scholar
- 71.Voogd AC, Nielsen M, Peterse JL, et al., Danish Breast Cancer Cooperative Group, Breast Cancer Cooperative Group of the European Organization for Research and Treatment of Cancer. Differences in risk factors for local and distant recurrence after breast-conserving therapy or mastectomy for stage I and II breast cancer: pooled results of two large European randomized trials. J Clin Oncol 2001;19:1688–1697PubMedGoogle Scholar
- 72.Woodward WA, Strom EA, Tucker SL, et al. Locoregional recurrence after doxorubicine-based chemotherapy and postmastectomy implications for breast cancer patients with early-stage disease and predictors for recurrence after postmastectomy radiation. Int J Radiat Oncol Biol Phys 2003;57:336–344PubMedCrossRefGoogle Scholar
- 73.Taghian A, Jeong JH, Mamounas E, et al. Patterns of locoregional failure in patients with operable breast cancer treated by mastectomy and adjuvant chemotherapy with or without tamoxifen and without radiotherapy. Results of five National Surgical Adjuvant Breast and Bowel Project Randomized Clinical Trials. J Clin Oncol 2004;22:4247–4254PubMedCrossRefGoogle Scholar
- 77.Gruber G, Bonetti M, Nasi ML, et al. Prognostic value of extracapsular tumor spread for locoregional control in premenopausal patients with node-positive breast cancer treated with classical cyclophosphamide, methotrexate, and fluorouracil: long–term observations from International Breast Cancer Study Group Trial VI. J Clin Oncol 2005;23:7089–7097PubMedCrossRefGoogle Scholar