Lymph Node Ratio as a Good Prognostic Factor for Patients with Pathologic N3a Breast Cancer with 10 or More Metastatic Axillary Lymph Nodes
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Purpose: Pathologic N3a breast cancer is defined as having 10 or more metastatic axillary lymph nodes and metastases to the infraclavicular (level III axillary lymph) node. This study aimed to determine clinicopathological factors and assess the importance of lymph node ratio (LNR) as a prognostic factor for patient with N3a breast cancer treated with surgery without neoadjuvant chemotherapy. Methods: Medical records of 154 patients who underwent surgery were retrospectively analyzed. Patients were pathologically diagnosed with N3a breast cancer between May 2004 and December 2014. LNR was defined as the number of metastatic lymph nodes divided by the total number of resected lymph nodes. It was calculated using the receiver operating characteristic (ROC) curve. The median follow up period was 94 months (range, 10–205 months). Results: Among 154 patients with N3a breast cancer, 70 (45.5%) had recurrence and 40 (26.0%) died during the follow-up period. The 5-year disease free survival (DFS) and overall survival (OS) rates after surgery were 63.0% and 85.9%, respectively. LNR>0.82 (hazard ratio [HR]: 2.271; 95% confidence interval [CI]: 1.413–3.649; p=0.001) was a prognostic factor significantly associated with DFS. LNR>0.68 (HR: 2.156; 95% CI: 1.146–4.044; p=0.017) and invasive ductal carcinoma (HR: 0.125; 95% CI: 0.017–0.915: p=0.041) were significantly associated with OS. Conclusion: Although LNR values associated with DFS and OS are slightly different, LNR is a good prognostic factor for patients with N3a breast cancer.
Abstract
Purpose: Pathologic N3a breast cancer is defined as having 10 or more metastatic axillary lymph nodes and metastases to the infraclavicular (level III axillary lymph) node. This study aimed to determine clinicopathological factors and assess the importance of lymph node ratio (LNR) as a prognostic factor for patient with N3a breast cancer treated with surgery without neoadjuvant chemotherapy. Methods: Medical records of 154 patients who underwent surgery were retrospectively analyzed. Patients were pathologically diagnosed with N3a breast cancer between May 2004 and December 2014. LNR was defined as the number of metastatic lymph nodes divided by the total number of resected lymph nodes. It was calculated using the receiver operating characteristic (ROC) curve. The median follow up period was 94 months (range, 10–205 months). Results: Among 154 patients with N3a breast cancer, 70 (45.5%) had recurrence and 40 (26.0%) died during the follow-up period. The 5-year disease free survival (DFS) and overall survival (OS) rates after surgery were 63.0% and 85.9%, respectively. LNR>0.82 (hazard ratio [HR]: 2.271; 95% confidence interval [CI]: 1.413–3.649; p=0.001) was a prognostic factor significantly associated with DFS. LNR>0.68 (HR: 2.156; 95% CI: 1.146–4.044; p=0.017) and invasive ductal carcinoma (HR: 0.125; 95% CI: 0.017–0.915: p=0.041) were significantly associated with OS. Conclusion: Although LNR values associated with DFS and OS are slightly different, LNR is a good prognostic factor for patients with N3a breast cancer.
참고문헌 (29)
- 홍세리, "Cancer Statistics in Korea: Incidence, Mortality, Survival, and Prevalence in 2018", Cancer Research and Treatment, 53(2), pp.301~315 (2021), 대한암학회[DOI]
- 강상율, "Breast Cancer Statistics in Korea in 2017: Data from a Breast Cancer Registry", Journal of Breast Cancer, 23(2), pp.115~128 (2020), 한국유방암학회[DOI]
- Koca E, "Outcomes of locally advanced breast cancer patients with ≥ 10 positive axillary lymph nodes", Med Oncol, 30, pp.615~ (2013)
- Jae-Myung Kim, "The prognosis factors among breast cancer patients with extensive axillary lymph node meta", 대한종양외과학회지, 14(1), pp.43~47 (2018), 대한종양외과학회[DOI]
- 허민희, "Metastatic axillary node ratio predicts recurrence and poor long-term prognosis in patients with advanced stage IIIC (pN3) breast cancer", Annals of Surgical Treatment and Research, 92(5), pp.340~347 (2017), 대한외과학회
- Nusbaum DJ, "Significance of lymph node ratio on survival of women with borderline ovarian tumors", Arch Gynecol Obstet, 301, pp.1289~1298 (2020)
- Liao Y, "The positive lymph node ratio predicts survival in T1-4N1-3M0 non-small cell lung cancer : a nomogram using the SEER database", Front Oncol, 10, pp.1356~ (2020)
- Cetin IA, "Lymph node ratio as an independent prognostic factor for breast cancer-related mortality in patients with node-positive breast cancer", J Cancer Res Ther, 16, pp.1387~ (2020)
- He M, "The lymph node ratio as an independent prognostic factor for node-positive triple-negative breast cancer", Oncotarget, 8, pp.44870~ (2017)
- Tonellotto F, "Impact of number of positive lymph nodes and lymph node ratio on survival of women with node-positive breast cancer", Eur J Breast Health, 15, pp.76~ (2019)
- Noh JM, "Prognostic significance of nodal involvement region in clinical stage IIIc breast cancer patients who received primary systemic treatment, surgery, and radiotherapy", Breast, 24, pp.637~641 (2015)
- Spronk PER, "Variation in use of neoadjuvant chemotherapy in patients with stage III breast cancer : results of the Dutch national breast cancer audit", Breast, 36, pp.34~38 (2017)
- Ai X, "Clinical outcomes of N3 breast cancer : a real-world study of a single institution and the US surveillance, epidemiology, and end results(SEER)database", Cancer Manag Res, 12, pp.5331~ (2020)
- 김윤영, "Prognostically Distinctive Subgroup in Pathologic N3 Breast Cancer", Journal of Breast Cancer, 19(2), pp.163~168 (2016), 한국유방암학회
- Grassadonia A, "Long-term outcome of breast cancer patients with pathologic N3a lymph node stage", Breast, 32, pp.79~86 (2017)
- Liu D, "Lymph node ratio and breast cancer prognosis : a meta-analysis", Breast Cancer, 21, pp.1~9 (2014)
- 김상원, "Lymph Node Ratio as a Risk Factor for Locoregional Recurrence in Breast Cancer Patients with 10 or More Axillary Nodes", Journal of Breast Cancer, 19(2), pp.169~175 (2016), 한국유방암학회
- 김재호, "Clinical significance of the lymph node ratio in N1 breast cancer", Radiation oncology journal, 35(3), pp.227~232 (2017), 대한방사선종양학회
- Man Hung, "Evaluating the Prediction of Breast Cancer Survival Using Lymph Node Ratio", Journal of Breast Cancer, 21(3), pp.315~320 (2018), 한국유방암학회[DOI]
- De la CruzKu GA, "Lymph node ratio as best prognostic factor in triplenegative breast cancer patients with residual disease after neoadjuvant chemotherapy", Breast J, 26, pp.1659~1666 (2020)
- Sakin A, "Lymph node ratio predicts long-term survival in lymph node-positive breast cancer", Eur J Breast Health, 16, pp.270~ (2020)
- Jin ML, "Modified lymph node ratio improves the prognostic predictive ability for breast cancer patients compared with other lymph node staging systems", Breast, 49, pp.93~100 (2020)
- Dent R, "Triple-negative breast cancer : clinical features and patterns of recurrence", Clin Cancer Res, 13, pp.4429~4434 (2007)
- Fallahpour S, "Breast cancer survival by molecular subtype : a population-based analysis of cancer registry data", CMAJ open, 5, pp.E734~9 (2017)
- Gonçalves Jr H, "Survival study of triple-negative and non–triple-negative breast cancer in a Brazilian cohort", Clin Med Insights Oncol, 12, pp.1179554918790563~ (2018)
- Luo SP, "Validation of the prognostic significance of the prognostic stage group according to the eighth edition of American Cancer Joint Committee on Cancer Staging System in triple-negative breast cancer: an analysis from surveillance, epidemiology, and end results 18 database", J Surg Res, 247, pp.211~219 (2020)
- Fidalgo F, "Lymphovascular invasion and histologic grade are associated with specific genomic profiles in invasive carcinomas of the breast", Tumor Biol, 36, pp.1835~1848 (2015)
- Schwartz AM, "Histologic grade remains a prognostic factor for breast cancer regardless of the number of positive lymph nodes and tumor size : a study of 161 708 cases of breast cancer from the SEER program", Arch Pathol Lab Med, 138, pp.1048~1052 (2014)
- Perou CM, "Molecular portraits of human breast tumours", Nature, 406, pp.747~752 (2000)
