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. 2013 Sep 3;109(5):1165-71.
doi: 10.1038/bjc.2013.465. Epub 2013 Aug 13.

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

S I Kim  1 , S-H Cho, J S Lee, H-G Moon, W C Noh, H J Youn, B K Ko, B-W Park
Affiliations

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

S I Kim et al. Br J Cancer. .

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.

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Figures

Figure 1
Figure 1
Empirical distributions of the estimated LNR cutoff values based on 10 000 bootstrap samples: (A) lower cutoff; (B) upper cutoff.
Figure 2
Figure 2
Kaplan–Meier OS estimates of breast cancer patients with pN1 disease according to the cLNR risk groups.
Figure 3
Figure 3
Kaplan–Meier OS estimates of breast cancer patients with pN1 disease according to PMRT: (A) all patients with pN1 disease; (B) patients with the low cLNR; and (C) patients with the intermediate cLNR. *Indicates P-value adjusted for multiple comparisons using Tukey's procedure.
See this image and copyright information in PMC

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