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. 2019 Apr 1;15(2):76-84.
doi: 10.5152/ejbh.2019.4414. eCollection 2019 Apr.

Impact of Number of Positive Lymph Nodes and Lymph Node Ratio on Survival of Women with Node-Positive Breast Cancer

Fabiana Tonellotto  1 , Anke Bergmann  2 , Karen de Souza Abrahão  2 , Suzana Sales de Aguiar  2 , Marcelo Adeodato Bello  1 , Luiz Claudio Santos Thuler  2
Affiliations

Impact of Number of Positive Lymph Nodes and Lymph Node Ratio on Survival of Women with Node-Positive Breast Cancer

Fabiana Tonellotto et al. Eur J Breast Health. .

Abstract

Objective: This study aimed to evaluate the association of axillary lymph node ratio (LNR) and number of positive lymph nodes (pN) with the risk of breast cancer recurrence and death.

Materials and methods: A retrospective cohort study of node-positive stage II and III breast cancer patients diagnosed and treated between 2008 and 2009 at the Brazilian National Cancer Institute (INCA), Brazil. Overall and disease-free survival curves for number of positive lymph nodes (pN) and lymph node ratio (LNR) risk groups were constructed using the Kaplan-Meier method and compared by the log-rank test. Multivariate analysis was performed using stepwise forward Cox regression models.

Results: In total, 628 women with node-positive breast cancer were included. Most patients (69.5%) had advanced clinical stage tumors (≥IIB). The median follow-up was 58 months (range: 3-92 months). The adjusted recurrence hazard of pN2 and pN3 patients was 2.47 (95% Confidence Interval [CI] 1.72-3.56) and 2.42 (1.62-3.60), respectively, compared to pN1 patients (p<0.001), while the hazard of intermediate (0.21-0.65) and high-risk (>0.65) LNR was 2.11 (1.49-3.00) and 3.19 (2.12-4.80), respectively, compared to low-risk LNR (≤0.20) patients (p<0.001). On the other hand, the hazard of death of pN2 and pN3 patients was 2.17 (1.42-3.30) and 2.41 (1.53-3.78), respectively (p<0.001), and the hazard of intermediate (0.21-0.65) and high-risk (>0.65) LNR patients was 1.70 (1.13-2.56) and 2.74 (1.75-4.28), respectively (p≤0.001).

Conclusion: Higher pN and LNR were associated with shorter disease-free survival and overall survival times.

Keywords: Breast cancer; disease-free survival; lymph node ratio; overall survival; positive lymph nodes.

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Conflict of interest statement

Conflict of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1. a–d
Figure 1. a–d
Kaplan-Meier Overall Survival estimates according to the number of positive lymph nodes (pN) and lymph node ratio (LNR) (a, b). Kaplan-Meier Disease Free Survival estimates according to the number of positive lymph nodes (pN) and lymph node ratio (LNR) (c, d)
See this image and copyright information in PMC

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