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. 2015 Jan 15;5(2):844-53.
eCollection 2015.

Number of negative lymph nodes should be considered for incorporation into staging for breast cancer

San-Gang Wu  1 , Yan Wang  2 , Juan Zhou  3 , Jia-Yuan Sun  2 , Feng-Yan Li  2 , Huan-Xin Lin  2 , Zhen-Yu He  2
Affiliations

Number of negative lymph nodes should be considered for incorporation into staging for breast cancer

San-Gang Wu et al. Am J Cancer Res. .

Abstract

This study aimed to investigate the prognostic value of the number of involved lymph nodes (pN), number of removed lymph nodes (RLNs), lymph node ratio (LNR), number of negative lymph nodes (NLNs), and log odds of positive lymph nodes (LODDS) in breast cancer patients. The records of 2,515 breast cancer patients who received a mastectomy or breast-conserving surgery were retrospectively reviewed. The log-rank test was used to compare survival curves, and Cox regression analysis was performed to identify prognostic factors. The median follow-up time was 64.2 months, and the 8-year disease-free survival (DFS) and overall survival (OS) were 74.6% and 82.3%, respectively. Univariate analysis showed that pN stage, LNR, number of RLNs, and number of NLNs were significant prognostic factors for DFS and OS (all, P < 0.05). LODDS was a significant prognostic factor for OS (P = 0.021). Multivariate analysis indicated that pN stage and the number of NLNs were independent prognostic factors for DFS and OS. A higher number of NLNs was associated with higher DFS and OS, and a higher number of involved lymph nodes were associated with poorer DFS and OS. Patients with a NLNs count > 9 had better survival (P < 0.001). Subgroup analysis showed that the NLNs count had a prognostic value in patients with different pT stages and different lymph node status (log-rank P < 0.05). For breast cancer, pN stage and NLNs count have a better prognostic value compared to the RLNs count, LNR, and LODDS. Number of negative lymph nodes should be considered for incorporation into staging for breast cancer.

Keywords: Breast cancer; lymph node ratio; lymph node staging; negative lymph nodes; prognosis.

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Figures

Figure 1
Figure 1
Impact of the number of negative lymph nodes on disease-free survival (A) and overall survival (B).
Figure 2
Figure 2
Impact of the number of negative lymph nodes on the disease-free survival of pT1 (A), pT2 (B), pT3 (C), and pT4 (D) stage patients, and overall survival of pT1 (E), pT2 (F), pT3 (G), and pT4 (H) stage patients.
Figure 3
Figure 3
Impact of the number of negative lymph nodes on the disease-free survival of pN0 stage patients (A) and pN positive patients (B), overall survival of pN0 stage patients (C) and pN positive patients (D).
See this image and copyright information in PMC

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