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The prognostic value of the nodal ratio in N1 breast cancer
BACKGROUND: Although the nodal ratio (NR) has been recognized as a prognostic factor in breast cancer, its clinical implication in patients with 1-3 positive nodes (N1) remains unclear. Here, we evaluated the prognostic value of the NR and identified other clinico-pathologic variables associated wit...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2011
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3198692/ https://www.ncbi.nlm.nih.gov/pubmed/21978463 http://dx.doi.org/10.1186/1748-717X-6-131 |
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author | Han, Tae Jin Kang, Eun Young Jeon, Wan Kim, Sung-Won Kim, Jee Hyun Kim, Yu Jung Park, So Yeon Kim, Jae Sung Kim, In Ah |
author_facet | Han, Tae Jin Kang, Eun Young Jeon, Wan Kim, Sung-Won Kim, Jee Hyun Kim, Yu Jung Park, So Yeon Kim, Jae Sung Kim, In Ah |
author_sort | Han, Tae Jin |
collection | PubMed |
description | BACKGROUND: Although the nodal ratio (NR) has been recognized as a prognostic factor in breast cancer, its clinical implication in patients with 1-3 positive nodes (N1) remains unclear. Here, we evaluated the prognostic value of the NR and identified other clinico-pathologic variables associated with poor prognosis in these patients. METHODS: We analyzed 130 patients with N1 invasive breast cancer who were treated at Seoul National University Bundang Hospital from March 2003 to December 2007. Disease-free survival (DFS), locoregional recurrence-free survival (LRRFS), and distant metastasis-free survival (DMFS) were compared according to the NR with a cut-off value of 0.15. RESULTS: We followed patients' recovery for a median duration of 59 months. An NR > 0.15 was found in 23.1% of patients, and a median of 18 nodes were dissected per patient (range 1-59). The NR was statistically independent from other prognostic variables, such as patient age, T stage, extent of surgery, pathologic factors in the chi square test. On univariate analysis, patients with a NR > 0.15 had significantly lower 5-year LRRFS (88.7% vs. 97.9%, p = 0.033) and 5-year DMFS (81.3% vs. 96.4%, p = 0.029) and marginally lower 5-year DFS (81.3% vs. 94.0%, p = 0.069) than those with a NR ≤0.15, respectively. Since the predictive power of the NR was found to differ with diverse clinical and pathologic variables, we performed adjusted analysis stratified by age, pathologic characteristics, and adjuvant treatments. Only young patients with a NR > 0.15 showed significantly lower DFS (p = 0.027) as well as those presenting an unfavorable pathologic profile such as advanced T stage (p = 0.034), histologic grade 3 (p = 0.034), positive lymphovascular invasion (p = 0.037), involved resection margin (p = 0.007), and no chemotherapy (p = 0.014) or regional radiotherapy treatment (p = 0.039). On multivariate analysis, a NR > 0.15 was significantly associated with lower DFS (p = 0.043) and DMFS (p = 0.012), but not LRRFS (p = 0.064). CONCLUSIONS: A NR > 0.15 was associated with an increased risk of recurrence, especially in young patients with unfavorable pathologic profiles. |
format | Online Article Text |
id | pubmed-3198692 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2011 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-31986922011-10-23 The prognostic value of the nodal ratio in N1 breast cancer Han, Tae Jin Kang, Eun Young Jeon, Wan Kim, Sung-Won Kim, Jee Hyun Kim, Yu Jung Park, So Yeon Kim, Jae Sung Kim, In Ah Radiat Oncol Research BACKGROUND: Although the nodal ratio (NR) has been recognized as a prognostic factor in breast cancer, its clinical implication in patients with 1-3 positive nodes (N1) remains unclear. Here, we evaluated the prognostic value of the NR and identified other clinico-pathologic variables associated with poor prognosis in these patients. METHODS: We analyzed 130 patients with N1 invasive breast cancer who were treated at Seoul National University Bundang Hospital from March 2003 to December 2007. Disease-free survival (DFS), locoregional recurrence-free survival (LRRFS), and distant metastasis-free survival (DMFS) were compared according to the NR with a cut-off value of 0.15. RESULTS: We followed patients' recovery for a median duration of 59 months. An NR > 0.15 was found in 23.1% of patients, and a median of 18 nodes were dissected per patient (range 1-59). The NR was statistically independent from other prognostic variables, such as patient age, T stage, extent of surgery, pathologic factors in the chi square test. On univariate analysis, patients with a NR > 0.15 had significantly lower 5-year LRRFS (88.7% vs. 97.9%, p = 0.033) and 5-year DMFS (81.3% vs. 96.4%, p = 0.029) and marginally lower 5-year DFS (81.3% vs. 94.0%, p = 0.069) than those with a NR ≤0.15, respectively. Since the predictive power of the NR was found to differ with diverse clinical and pathologic variables, we performed adjusted analysis stratified by age, pathologic characteristics, and adjuvant treatments. Only young patients with a NR > 0.15 showed significantly lower DFS (p = 0.027) as well as those presenting an unfavorable pathologic profile such as advanced T stage (p = 0.034), histologic grade 3 (p = 0.034), positive lymphovascular invasion (p = 0.037), involved resection margin (p = 0.007), and no chemotherapy (p = 0.014) or regional radiotherapy treatment (p = 0.039). On multivariate analysis, a NR > 0.15 was significantly associated with lower DFS (p = 0.043) and DMFS (p = 0.012), but not LRRFS (p = 0.064). CONCLUSIONS: A NR > 0.15 was associated with an increased risk of recurrence, especially in young patients with unfavorable pathologic profiles. BioMed Central 2011-10-06 /pmc/articles/PMC3198692/ /pubmed/21978463 http://dx.doi.org/10.1186/1748-717X-6-131 Text en Copyright ©2011 Han et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Research Han, Tae Jin Kang, Eun Young Jeon, Wan Kim, Sung-Won Kim, Jee Hyun Kim, Yu Jung Park, So Yeon Kim, Jae Sung Kim, In Ah The prognostic value of the nodal ratio in N1 breast cancer |
title | The prognostic value of the nodal ratio in N1 breast cancer |
title_full | The prognostic value of the nodal ratio in N1 breast cancer |
title_fullStr | The prognostic value of the nodal ratio in N1 breast cancer |
title_full_unstemmed | The prognostic value of the nodal ratio in N1 breast cancer |
title_short | The prognostic value of the nodal ratio in N1 breast cancer |
title_sort | prognostic value of the nodal ratio in n1 breast cancer |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3198692/ https://www.ncbi.nlm.nih.gov/pubmed/21978463 http://dx.doi.org/10.1186/1748-717X-6-131 |
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