PROGNOSTIC VALUE OF LYMPH NODE RATIO IN BREAST CANCER PATIENTS WITH PATHOLOGICALLY POSITIVE AXILLARY LYMPH NODES; SINGLE INSTITUTE EXPERIENCE

El-Sheshtawy W. H.*, Abdelbadea M., Esmat M., Abd-Elhamid N. M., El Agamawy A. Y.

ABSTRACT

Purpose: To detect the prognostic impact of lymph node ratio (LNR) on type of relapse, disease free survival (DFS) and overall survival (OS) in breast cancer patients with pathologically involved lymph nodes in comparison to pathological nodal (pN) stage. Methods: This retrospective study included 306 breast cancer patients with positive axillary LN treated with upfront surgery in the period between January 2008 and December 2013 at Al Azhar University Hospital, Egypt. The LNR defined as positive lymph nodes number divided by excised lymph nodes number multiplied by 100. Results: After a median follow up period of 49 months, LNR classification into three groups (20%, >20-65% and >65%) found to be the most predictive factor for DFS and OS. Systemic relapse was affected significantly by pN stage and LNR (P= 0.008 and 0.001 respectively) while locoregional relapse rate did not affect significantly by either one (P= 0.078 and 0.077 respectively). In univariate analysis tumor stage, pN Stage, LNR, Capsular invasion, ER, PR, and HER2 neu had statistically significant effect on total relapse rate (P= 0.013, P= 0.013, P= 0.000, P= 0.002, P= 0.007, P= 0.044 respectively). However in multivariate analysis LNR and ER were the only factors affecting the relapse rate significantly (P= 0.01 and 0.03 respectively). Both pN stage and LNR (20/65) affected the DFS (P= 0.000 and 0.000 respectively) and OS significantly (P= 0.008 and 0.003 respectively). Conclusion: LNR classification (20/65) found to be the most sensitive one in this study. LNR was at least equal to pN stage as a prognostic factor for DFS and OS, while it was superior to pN stage in prediction of relapse rate; which makes LNR better alternative to pN stage.

Keywords: Breast cancer; Lymph node ratio; Positive axillary lymph nodes and pN stage.