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Ratio Between Positive Lymph Nodes and Total Excised Axillary Lymph Nodes as an Independent Prognostic Factor for Overall Survival in Patients with Nonmetastatic Lymph Node-Positive Breast Cancer

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The status of the axillary lymph nodes in nonmetastatic lymph node-positive breast cancer (BC) patients remains the single most important determinant of overall survival (OS). Although the absolute number of nodes involved with cancer is important for prognosis, the role of the total number of excised nodes has received less emphasis. Thus, several studies have focused on the utility of the axillary lymph node ratio (ALNR) as an independent prognostic indicator of OS. However, most studies suffered from shortcomings, such as including patients who received neoadjuvant therapy or failing to consider the use of adjuvant therapy and tumor receptor status in their analysis.

Methods

We conducted a single-center retrospective review of 669 patients with nonmetastatic lymph node-positive BC. Data collected included patient demographics; breast cancer risk factors; tumor size, histopathological, receptor, and lymph node status; and treatment modalities used. Patients were subdivided into four groups according to ALNR value (<.25, .25–.49, .50–.74, .75–1.00). Study parameters were compared at the univariate and multivariate levels for their effect on OS.

Results

On univariate analysis, both the absolute number of positive lymph nodes and the ALNR were significant predictors of OS. On multivariate analysis, only the ALNR remained an independent predictor of OS, with a 2.5-fold increased risk of dying at an ALNR of ≥.25.

Conclusions

Our study demonstrates that ALNR is a stronger factor in predicting OS than the absolute number of positive axillary lymph nodes.

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Authors and Affiliations

  1. Department of Internal Medicine, Division of Hematology/Oncology, American University of Beirut Medical Center, Beirut, Lebanon

    Hassan A. Hatoum MD, Nagi S. El-Saghir MD, Khaled M. Musallam MD, Ziad Salem MD, Achraf A. Shamseddine BSc, Karine Al-Feghali BSc & Ali I. Shamseddine MD

  2. Department of Surgery, Division of General Surgery, American University of Beirut Medical Center, Beirut, Lebanon

    Faek R. Jamali MD, Jaber Abbas MD & Mohamad Khalife MD

  3. Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon

    Muhieddine Seoud MD

  4. School of Pharmacy, Lebanese American University, Byblos, Lebanon

    Hani Dimassi PhD

  5. Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon

    Fouad I. Boulos MD & Ayman N. Tawil MD

  6. Department of Radiation Oncology, American University of Beirut Medical Center, Beirut, Lebanon

    Fadi B. Geara MD

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  1. Hassan A. Hatoum MD
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  15. Ali I. Shamseddine MD
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Correspondence to Ali I. Shamseddine MD.

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Hatoum, H.A., Jamali, F.R., El-Saghir, N.S. et al. Ratio Between Positive Lymph Nodes and Total Excised Axillary Lymph Nodes as an Independent Prognostic Factor for Overall Survival in Patients with Nonmetastatic Lymph Node-Positive Breast Cancer. Ann Surg Oncol 16, 3388–3395 (2009). https://doi.org/10.1245/s10434-009-0653-8

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  • DOI: https://doi.org/10.1245/s10434-009-0653-8

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