Cancer Res Treat.  2016 Oct;48(4):1373-1381. 10.4143/crt.2015.475.

Prognostic Value of Axillary Nodal Ratio after Neoadjuvant Chemotherapy of Doxorubicin/Cyclophosphamide Followed by Docetaxel in Breast Cancer: A Multicenter Retrospective Cohort Study

• Kim SH
• Jung KH
• Kim TY
• Im SA
• Choi IS
• Chae YS
• Baek SK
• Kang SY
• Park S
• Park IH
• Lee KS
• Choi YJ
• Lee S
• Sohn JH
• Park YH
• Im YH
• Ahn JH
• Kim SB
• Kim JH

• KMID: 2356239
• DOI: http://doi.org/10.4143/crt.2015.475

Abstract

PURPOSE
The purpose of this study is to investigate the prognostic value of lymph node (LN) ratio (LNR) in patients with breast cancer after neoadjuvant chemotherapy.
MATERIALS AND METHODS
This retrospective analysis is based on the data of 814 patientswith stage II/III breast cancer treated with four cycles of doxorubicin/cyclophosphamide followed by four cycles of docetaxel before surgery. We evaluated the clinical significance of LNR (3 categories: low 0-0.20 vs. intermediate 0.21-0.65 vs. high 0.66-1.00) using a Cox proportional regression model.
RESULTS
A total of 799 patients underwent breast surgery. Pathologic complete response (pCR, ypT0/isN0) was achieved in 129 patients (16.1%) (hormone receptor [HR] +/human epidermal growth factor receptor 2 [HER2] -, 34/373 [9.1%]; HER2+, 45/210 [21.4%]; triple negative breast cancer, 50/216 [23.1%]). The mean numbers of involved LN and retrieved LN were 2.70 (range, 0 to 42) and 13.98 (range, 1 to 64), respectively. The mean LNR was 0.17 (low, 574 [71.8%]; intermediate, 170 [21.3%]; high, 55 [6.9%]). In univariate analysis, LNR showed significant association with a worse relapse-free survival (3-year relapse-free survival rate 84.8% in low vs. 66.2% in intermediate vs. 54.3% in high; p < 0.001, log-rank test). In multivariate analysis, LNR did not show significant association with recurrence after adjusting for other clinical factors (age, histologic grade, subtype, ypT stage, ypN stage, lymphatic or vascular invasion, and pCR). In subgroup analysis, the LNR system had good prognostic value in HR+/HER2-subtype.
CONCLUSION
LNR is not superior to ypN stage in predicting clinical outcome of breast cancer after neoadjuvant chemotherapy. However, the prognostic value of the LNR system in HR+/HER2-patients is notable and worthy of further investigation.

Keyword

Lymph nodes; Lymph node excision; Neoadjuvant therapy; Breast neoplasms; Prognosis

MeSH Terms

Breast Neoplasms*
Breast*
Cohort Studies*
Drug Therapy*
Humans
Lymph Node Excision
Lymph Nodes
Multivariate Analysis
Neoadjuvant Therapy
Prognosis
Receptor, Epidermal Growth Factor
Recurrence
Retrospective Studies*
Survival Rate
Triple Negative Breast Neoplasms
Receptor, Epidermal Growth Factor

Figure

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  Fig. 1. Survival of patients according to lymph node ratio (LNR) status: relapse-free survival (A) and overall survival (B).

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  Fig. 2. Relapse-free survival of patients according to lymph node ratio (LNR) status and subtype: hormone receptor +/human epidermal growth factor receptor 2 (HER2) – (A), HER2+ (B), and triple negative breast cancer (C).

Reference

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