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Lymph node ratio and pN staging in patients with node-positive breast cancer: a report from the Korean breast cancer society

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Abstract

Patients with node-positive breast cancer are currently classified according to pN stage. Lymph node ratio (LNR), the ratio of positive to total removed lymph nodes, maybe a more useful prognostic factor in these patients. We therefore compared LNR and pN staging as prognostic factors in patients with node-positive breast cancer. Using two large prospective databases of the Korean Breast Cancer Registry (KBCR) and the Asan Medical Center (AMC) Breast Cancer Center of patients with LN-positive breast cancer from 1988 to 2005, we compared the ability of LNR and pN stage to predict patient survival by Cox regression analysis in the overall patient cohort and in subgroups categorized by age and intrinsic subtype. Patients were categorized into low- (≤0.20), intermediate- (>0.20 and ≤0.65), and high-risk (>0.65) LNR groups. The difference in mortality risk was greater among LNR groups than among patients staged pN1, pN2, and pN3, as assessed by disease-free survival (DFS), cancer-specific survival (CSS), and overall survival (OS) rates. In contrast to LNR risk categories, the survival curves for pN1 and pN2 stage patients overlapped in those aged <35 years and those with her2/neu-enriched or triple-negative tumors. These findings were validated by analyzing a nationwide registry of 15,488 node-positive patients, which showed that patients with pN1 and intermediate LNR risk had poorer DFS (HR 1.7, 95% CI 1.4–2.2) and CSS (HR 1.6, 95% CI 1.1–2.2) than patients with pN2 and low LNR risk. LNR is a better predictor of prognosis than pN stage in women with breast cancer, especially in high-risk patients, including younger women and women with her2/neu-enriched or triple-negative tumors. Treatment decisions should be based on LNR rather than on pN stage.

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The authors declare no conflict of interest. The authors confirm that there is no financial arrangement with anyone.

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Authors and Affiliations

  1. Department of Surgery, College of Medicine, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap-dong, Songpa-gu, Seoul, 138-736, Korea

    Sei Hyun Ahn, Hee Jeong Kim & Jong Won Lee

  2. Department of Pathology, College of Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

    Gyung-Yub Gong

  3. Department of Surgery, College of Medicine, Seoul National University, Seoul, Korea

    Dong-Yong Noh

  4. Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

    Jung Hyun Yang

  5. Department of Surgery, College of Medicine, Catholic University of Korea, Seoul, Korea

    Sang Seol Jung

  6. Department of Surgery, Kyungpook National University, College of Medicine, Daegu, Korea

    Ho Yong Park

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  1. Sei Hyun Ahn
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  2. Hee Jeong Kim
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Correspondence to Sei Hyun Ahn.

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Ahn, S.H., Kim, H.J., Lee, J.W. et al. Lymph node ratio and pN staging in patients with node-positive breast cancer: a report from the Korean breast cancer society. Breast Cancer Res Treat 130, 507–515 (2011). https://doi.org/10.1007/s10549-011-1730-9

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  • DOI: https://doi.org/10.1007/s10549-011-1730-9

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