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Dwivedi S, Shankaran R, Saidha N, Sharma R, Mukherjee D, Dwivedi S, Agarwal V, Arnav A, Chaudhary A, Hans R. Observational Study to Determine the Involvement of Level III Lymph Nodes in Case of Clinically Positive Level II Nodes in Carcinoma Breast. Indian J Surg Oncol 2023; 14:106-112. [PMID: 36891429 PMCID: PMC9986151 DOI: 10.1007/s13193-022-01618-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 08/06/2022] [Indexed: 12/24/2022] Open
Abstract
Management of breast cancer has gradually shifted from era of radical surgery to present days of multimodality management and conservatism. Management of carcinoma breast is primarily multimodality of which surgery is one of the important roles to play. Our study is a prospective observational study to determine the involvement of level III axillary lymph nodes in clinically involved axilla with grossly involved lower-level axillary nodes. Underestimation of a number of involved nodes at level III shall result in inaccuracy of subset risk stratification leading to substandard prognostication. The enigma of not addressing presumably involved nodes thereby altering the staging vs acquired morbidity has always been a contentious issue. Mean lymph node harvest at the lower level (I and II) was 17.9 ± 6.3 (range: 6-32) while positive lower-level axillary lymph node involvement was 6.5 ± 6.5 (range: 1-27). The mean ± SD for level III positive lymph node involvement was 1.46 ± 1.69 (range: 0-8). Our prospective observational study though limited by the number and years of follow-up has demonstrated that the presence of more than three positive LN at a lower level increases the risk for higher nodal involvement substantially. It is also evident in our study that PNI, ECE, and LVI increased the probability of stage up-gradation. LVI was found to be a significant prognostic factor for apical LN involvement in multivariate analysis. On multivariate logistic regression > 3 pathological positive lymph nodes at the level I and II and LVI involvement elevated the risk of involvement at level III by 11 and 46 times, respectively. It is recommended that patients who have a positive pathological surrogate marker of aggressiveness should be evaluated perioperatively for level III involvement, especially in the setting of visible grossly involved nodes. The patient should be counseled and informed decision to perform complete axillary lymph node dissection with the added risk of morbidity should be contemplated.
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Affiliation(s)
- Surjeet Dwivedi
- Dept of Surgery, Surgical Oncologist, Command Hospital Air Force Bangalore, Bengaluru, India 560007
| | - R. Shankaran
- INHS Ashvini, Command Hospital Mumbai, Mumbai, India
| | | | - Rohit Sharma
- Dept of MDTC, Army Hospital Delhi, New Delhi, India
| | | | | | | | | | | | - Raj Hans
- Army Hospital R & R New, Delhi, New Delhi, India
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Houvenaeghel G, Cohen M, Classe JM, Reyal F, Mazouni C, Chopin N, Martinez A, Daraï E, Coutant C, Colombo PE, Gimbergues P, Chauvet MP, Azuar AS, Rouzier R, Tunon de Lara C, Muracciole X, Agostini A, Bannier M, Charaffe Jauffret E, De Nonneville A, Goncalves A. Lymphovascular invasion has a significant prognostic impact in patients with early breast cancer, results from a large, national, multicenter, retrospective cohort study. ESMO Open 2021; 6:100316. [PMID: 34864349 PMCID: PMC8645922 DOI: 10.1016/j.esmoop.2021.100316] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/28/2021] [Accepted: 10/31/2021] [Indexed: 11/17/2022] Open
Abstract
Background We determined the prognostic impact of lymphovascular invasion (LVI) in a large, national, multicenter, retrospective cohort of patients with early breast cancer (BC) according to numerous factors. Patients and methods We collected data on 17 322 early BC patients treated in 13 French cancer centers from 1991 to 2013. Survival functions were calculated using the Kaplan–Meier method and multivariate survival analyses were carried out using the Cox proportional hazards regression model adjusted for significant variables associated with LVI or not. Two propensity score-based matching approaches were used to balance differences in known prognostic variables associated with LVI status and to assess the impact of adjuvant chemotherapy (AC) in LVI-positive luminal A-like patients. Results LVI was present in 24.3% (4205) of patients. LVI was significantly and independently associated with all clinical and pathological characteristics analyzed in the entire population and according to endocrine receptor (ER) status except for the time period in binary logistic regression. According to multivariate analyses including ER status, AC, grade, and tumor subtypes, the presence of LVI was significantly associated with a negative prognostic impact on overall (OS), disease-free (DFS), and metastasis-free survival (MFS) in all patients [hazard ratio (HR) = 1.345, HR = 1.312, and HR = 1.415, respectively; P < 0.0001], which was also observed in the propensity score-based analysis in addition to the association of AC with a significant increase in both OS and DFS in LVI-positive luminal A-like patients. LVI did not have a significant impact in either patients with ER-positive grade 3 tumors or those with AC-treated luminal A-like tumors. Conclusion The presence of LVI has an independent negative prognostic impact on OS, DFS, and MFS in early BC patients, except in ER-positive grade 3 tumors and in those with luminal A-like tumors treated with AC. Therefore, LVI may indicate the existence of a subset of luminal A-like patients who may still benefit from adjuvant therapy. In a study of 17 322 early BC patients, LVI had a significant independent negative prognostic impact on survival. LVI negatively impacted survival in almost every patient category and cancer subtype, with and without AC. LVI did not have a negative survival impact in patients with ER+ grade 3 or with luminal A-like tumors with chemotherapy. Results suggest a possible benefit of AC in LVI-positive luminal A-like patients.
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Affiliation(s)
- G Houvenaeghel
- Department of Surgical Oncology, CRCM, Institut Paoli-Calmettes, Aix-Marseille University, CNRS, INSERM, Marseille, France.
| | - M Cohen
- Department of Surgical Oncology, CRCM, Institut Paoli-Calmettes, Aix-Marseille University, CNRS, INSERM, Marseille, France
| | - J M Classe
- Institut René Gauducheau, Site Hospitalier Nord, St Herblain, France
| | - F Reyal
- Institut Curie, Paris, France
| | - C Mazouni
- Institut Gustave Roussy, Villejuif, France
| | - N Chopin
- Centre Léon Bérard, Lyon, France
| | - A Martinez
- Centre Claudius Regaud, Toulouse, France
| | - E Daraï
- Hôpital Tenon, Paris, France
| | - C Coutant
- Centre Georges François Leclerc, Dijon, France
| | | | | | | | - A S Azuar
- Hôpital de Grasse, Chemin de Clavary, Grasse, France
| | - R Rouzier
- Hôpital René Huguenin, Saint Cloud, France
| | | | | | - A Agostini
- Department of Obstetrics and Gynocology, Hôpital de la Conception, Marseille, France
| | - M Bannier
- Department of Surgical Oncology, CRCM, Institut Paoli-Calmettes, Aix-Marseille University, CNRS, INSERM, Marseille, France
| | - E Charaffe Jauffret
- Department of Pathology, CRCM, Institut Paoli-Calmettes, Aix-Marseille University, Marseille, France
| | - A De Nonneville
- Department of Medical Oncology, CRCM, Institut Paoli-Calmettes, Aix-Marseille University, CNRS, INSERM, Marseille, France
| | - A Goncalves
- Department of Medical Oncology, CRCM, Institut Paoli-Calmettes, Aix-Marseille University, CNRS, INSERM, Marseille, France
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Hu J, Xia X, Yang H, Yu Y. Dissection of Level III Axillary Lymph Nodes in Breast Cancer. Cancer Manag Res 2021; 13:2041-2046. [PMID: 33664591 PMCID: PMC7924124 DOI: 10.2147/cmar.s290345] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 01/31/2021] [Indexed: 11/23/2022] Open
Abstract
Axillary lymph node dissection is an indispensable step in modified radical mastectomy for breast cancer. It is the most reliable method and the golden standard to determine the status of axillary lymph nodes. It is also of great importance to evaluate the prognosis and develop treatment plans for breast cancer patients. Axillary lymph node dissection can be anatomically divided into levels I, II, and III. Level I and Level II axillary lymph dissection is the standard clinical treatment of axillary lymph nodes positive breast cancer, whereas level III axillary lymph node dissection has been controversial. Level III axillary lymph node metastasis is one of the important factors that can easily cause distant metastasis and recurrence. It is also an important index to estimate the prognosis of breast cancer patients. To facilitate the decision of whether or not to perform level III lymph node dissection, we reviewed the indications, complications, and surgical procedures of level III lymph node dissection.
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Affiliation(s)
- Jiejie Hu
- Breast Surgery Department, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou City, Zhejiang Province, People's Republic of China
| | - Xianghou Xia
- Breast Surgery Department, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou City, Zhejiang Province, People's Republic of China
| | - Hongjian Yang
- Breast Surgery Department, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou City, Zhejiang Province, People's Republic of China
| | - Yang Yu
- Breast Surgery Department, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou City, Zhejiang Province, People's Republic of China
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Kong Y, Yang A, Xie X, Zhang J, Xu H, Li M, Lyu N, Wei W. Impact of the extent of axillary surgery in patients with N2-3 disease in the de-escalation era: a propensity score-matched study. Clin Transl Oncol 2020; 23:526-535. [PMID: 32632654 DOI: 10.1007/s12094-020-02444-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 06/25/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Reduction of surgeries in axillary has been proved feasible in breast cancer with negative and limited involved axillary lymph nodes. However, for women with a heavy axillary burden, the extent of dissection is still arguable. PATIENTS AND METHODS From a total of 7042 patients with breast cancer who underwent surgical treatments between 2008 and 2014, 692 (9.85%) patients with the axillary staging of N2-3M0 were classified into Level I-II dissection group and Level I-III dissection group. 203 pairs of patients were matched by the propensity score. RESULTS The positive rate of level-III lymph nodes is 62.4% in patients who underwent Level I-III dissection. There are 67 (22.1%) patients who experienced rise in staging from N2 to N3 due to level-III dissection. With a median follow-up of 62.4 months, no significant difference was observed in RFS (P = 0.897), MFS (P = 0.610) and OS (P = 0.755) between level I-II group and level I-III group. The same results were observed in the independent analysis of neoadjuvant and non-neoadjuvant subgroups. The binary regression model showed the positivity of level-III is only associated with involved lymph nodes in level-II. CONCLUSION Additional level-III dissection has a limited impact on survival but still valuable in an accurate stage. The reduction of surgeries in axillary should be treated with discretion in breast cancer patients with a heavy axillary burden.
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Affiliation(s)
- Y Kong
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Breast Oncology, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China
| | - A Yang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Breast Oncology, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China
| | - X Xie
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Breast Oncology, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China
| | - J Zhang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Breast Oncology, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China
| | - H Xu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Breast Oncology, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China
| | - M Li
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - N Lyu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Minimally Invasive Interventional Radiology, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China.
| | - W Wei
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Breast Oncology, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China.
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Serre E, Diguisto C, Body G, Raimond E, Bendifallah S, Touboul C, Graesslin O, Carcopino X, Ballester M, Daraï E, Ouldamer L. [Prognostic significance of groin lymph node ratio in vulvar squamous cell carcinoma]. ACTA ACUST UNITED AC 2020; 48:729-735. [PMID: 32339764 DOI: 10.1016/j.gofs.2020.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aim was to review the clinical impact of lymph node ratio (LNR) of groin metastatic nodal disease in women with vulvar squamous cell carcinoma. MATERIAL AND METHODS Cohort study of women with vulvar squamous cell carcinoma, managed between January 2005 and December 2015, in five institutions in France with prospectively maintained databases (French multicenter tertiary care centers). POPULATION In total, 636 women managed for VSCC of whom 508 (79.9%) underwent surgical groin nodal staging. MAIN OUTCOME MEASURES Comparison of overall and recurrence free survival between women according to LNR. RESULTS In total, 176 women (34.6%) had at least one positive lymph node (LN). There was a significant differences for the 5-year overall survival and recurrence free survival rates between women with LNR>0.2 and women with LNR<0.2. CONCLUSION LNR seems to be a significant prognostic factor in women with vulvar squamous cell carcinoma.
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Affiliation(s)
- E Serre
- Department of Gynecology, CHU de Tours, Tours, France; Inserm U1069, Université François-Rabelais, Tours, France
| | - C Diguisto
- Department of Gynecology, CHU de Tours, Tours, France
| | - G Body
- Department of Gynecology, CHU de Tours, Tours, France; Inserm U1069, Université François-Rabelais, Tours, France
| | - E Raimond
- Department of Obstetrics and Gynecology, Institute Alix-de-Champagne, University Hospital, Reims, France
| | - S Bendifallah
- Department of Obstetrics and Gynecology, GRC-6 UPMC, Hôpital Tenon, Université Pierre et Marie-Curie, AP-HP, Paris 6, France; UMR S 707, Epidemiology, Information Systems, Modeling, Université Pierre et Marie-Curie, Paris, France
| | - C Touboul
- Department of Obstetrics and Gynecology, centre hospitalier intercommunal, Créteil, France
| | - O Graesslin
- Department of Obstetrics and Gynecology, Institute Alix-de-Champagne, University Hospital, Reims, France
| | - X Carcopino
- Department of Gynecological surgery, AP-HP, Marseille, France
| | - M Ballester
- Department of Obstetrics and Gynecology, Institute Alix-de-Champagne, University Hospital, Reims, France; Inserm UMR S 938, Université Pierre et Marie-Curie, Paris, France
| | - E Daraï
- Department of Obstetrics and Gynecology, GRC-6 UPMC, Hôpital Tenon, Université Pierre et Marie-Curie, AP-HP, Paris 6, France; Inserm UMR S 938, Université Pierre et Marie-Curie, Paris, France
| | - L Ouldamer
- Department of Gynecology, CHU de Tours, Tours, France; Inserm U1069, Université François-Rabelais, Tours, France.
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Zhou J, Lin Z, Lyu M, Chen N, Liao H, Wang Z, Hao J, Yan C, Liu L. Prognostic value of lymph node ratio in non-small-cell lung cancer: a meta-analysis. Jpn J Clin Oncol 2020; 50:44-57. [PMID: 31735973 DOI: 10.1093/jjco/hyz120] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 07/07/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND This meta-analysis aimed to investigate the prognostic value of lymph node ratio in non-small-cell lung cancer. METHODS We searched systematically for eligible studies in PubMed, Web of Science, Medline (via Ovid) and Cochrane library through 6 November 2018. The primary outcome was overall survival. Disease-free survival and cancer-specific survival were considered as secondary outcomes. Hazard ratio with corresponding 95% confidence interval were pooled. Quality assessment of included studies was conducted. Subgroup analyses were performed based on N descriptors, types of tumor resection, types of lymphadenectomy and study areas. Sensitivity analysis and evaluation of publication bias were also performed. RESULTS Altogether, 20 cohorts enrolling 76 929 patients were included. Mean Newcastle-Ottawa Scale was 7.65 ± 0.59, indicating the studies' quality was high. The overall result showed non-small-cell lung cancer patients with lower lymph node ratio was associated with better overall survival (HR: 1.946; 95% CI: 1.746-2.169; P < 0.001), disease-free survival (HR: 2.058; 95% CI: 1.717-2.467; P < 0.001) and cancer-specific survival (HR: 2.149; 95% CI: 1.864-2.477; P < 0.001). Subgroup analysis prompted types of lymphadenectomy and the station of positive lymph node have an important effect on the prognosis. No significant discovery was found in sensitivity analysis. CONCLUSION Patients with lower lymph node ratio was associated with better survival, indicating that lymph node ratio may be a promising prognostic predictor in non-small-cell lung cancer. The type of lymphadenectomy, an adequate examined number and the removed stations should be considered for more accurate prognosis assessment.
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Affiliation(s)
- Jian Zhou
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Zhangyu Lin
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Mengyuan Lyu
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Nan Chen
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Hu Liao
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, China
| | - Zihuai Wang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Jianqi Hao
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Chunyi Yan
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Lunxu Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, China
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Cheraghlou S, Agogo GO, Girardi M. Evaluation of Lymph Node Ratio Association With Long-term Patient Survival After Surgery for Node-Positive Merkel Cell Carcinoma. JAMA Dermatol 2019; 155:803-811. [PMID: 30825411 PMCID: PMC6583886 DOI: 10.1001/jamadermatol.2019.0267] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 02/12/2019] [Indexed: 12/18/2022]
Abstract
Importance Merkel cell carcinoma (MCC) carries the highest mortality rate among cutaneous cancers and is rapidly rising in incidence. Identification of prognostic indicators may help guide patient counseling and treatment planning. Lymph node ratio (LNR), the ratio of positive lymph nodes to the total number of examined lymph nodes, is an established prognostic indicator in other cancers. Objectives The primary objective was to evaluate the association between LNR and patient survival after surgery for node-positive MCC. The secondary objective was to evaluate whether the survival rates associated with adjuvant therapies vary by patient LNR status. Design, Setting, and Participants Retrospective cohort study of patients with node-positive MCC treated with surgery and lymphadenectomy. We queried the National Cancer Database (NCDB) and the Surveillance, Epidemiology, and End Results (SEER) registry for patient records. Data originated from 2004 through 2017 for the NCDB and from 1973 through 2016 for the SEER registry. The SEER registry comprises a population-based US cohort while cases from the NCDB include all reportable cases from Commission on Cancer-accredited facilities and represents approximately 70% of all newly diagnosed cancers in the United States. All data analysis took place between August 1, 2018, and February 11, 2019. Exposures The ratio of positive lymph nodes to the total number of examined lymph nodes, LNR, was stratified into quartiles. Main Outcomes and Measures Overall survival (NCDB) and disease-specific survival (SEER). Results We identified 736 eligible cases in the NCDB and 538 eligible cases in the SEER registry. Among these 1274 patients, the mean (SD) age was 71.1 (11.5) years, and 401 (31.5%) were women. After controlling for clinical and tumor factors including AJCC N staging, patient LNR of 0.07 to 0.31 (hazard ratio [HR], 1.37; 95% CI, 1.03-1.81) and greater than 0.31 (HR, 2.84; 95% CI, 2.10-3.86) was associated with significantly worse survival than an LNR less than 0.07. Univariate supplementary analysis performed in the SEER data set revealed a similar association of LNR with disease-specific survival. For patients with an LNR greater than 0.31, treatment with surgery and adjuvant chemoradiation therapy was associated with improved survival compared with surgery and adjuvant radiation therapy alone (HR, 0.61; 95% CI, 0.38-0.97), while this was not found for patients with an LNR of 0.31 or lower (HR, 0.93; 95% CI, 0.65-1.33). Conclusions and Relevance For lymph node-positive MCC, LNR offers a potentially prognostic metric alongside traditional TNM staging that may be useful for both patient counseling and treatment planning after surgery.
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Affiliation(s)
- Shayan Cheraghlou
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | - George O. Agogo
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Michael Girardi
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
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Fortea-Sanchis C, Martínez-Ramos D, Escrig-Sos J. The lymph node status as a prognostic factor in colon cancer: comparative population study of classifications using the logarithm of the ratio between metastatic and nonmetastatic nodes (LODDS) versus the pN-TNM classification and ganglion ratio systems. BMC Cancer 2018; 18:1208. [PMID: 30514228 PMCID: PMC6280498 DOI: 10.1186/s12885-018-5048-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 11/06/2018] [Indexed: 12/13/2022] Open
Abstract
Background pN stage in the TNM classification has been the “gold standard” for lymph node staging of colorectal carcinomas, but this system recommends collecting at least 12 lymph nodes for the staging to be reliable. However, new prognostic staging systems have been devised, such as the ganglion quotients or lymph node ratios and natural logarithms of the lymph node odds methods. The aim of this study was to establish and validate the predictive and prognostic ability of the lymph node ratios and natural logarithms of the lymph node odds staging systems and to compare them to the pN nodal classification of the TNM system in a population sample of patients with colon cancer. Methods A multicentric population study between January 2004 and December 2007. The inclusion criteria were that the patients were: diagnosed with colon cancer, undergoing surgery with curative intent, and had a complete anatomopathological report. We excluded patients with cancer of the rectum or caecal appendix with metastases at diagnosis. Survival analysis was performed using the Kaplan–Meier actuarial method and the Log-Rank test was implemented to estimate the differences between groups in terms of overall survival and disease-free survival. Multivariate survival analysis was performed using Cox regression. Results We analysed 548 patients. For the overall survival, the lymph node ratios and natural logarithms of the lymph node odds curves were easier to discriminate because their separation was clearer and more balanced. For disease-free survival, the discrimination between the pN0 and pN1 groups was poor, but this phenomenon was adequately corrected for the lymph node ratios and natural logarithms of the lymph node odds curves which could be sufficiently discriminated to be able to estimate the survival prognosis. Conclusions Lymph node ratios and natural logarithms of the lymph node odds techniques can more precisely differentiate risk subgroups from within the pN groups. Of the three methods tested in this study, the natural logarithms of the lymph node odds was the most accurate for staging non-metastatic colon cancer. Thus helping to more precisely adjust and individualise the indication for adjuvant treatments in these patients.
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Affiliation(s)
- Carlos Fortea-Sanchis
- Department of Surgery, Division of Colorectal Surgery, Consorcio Hospitalario Provincial de Castellón, Av. Doctor Clara, 19, 12002, Castellón, Spain.
| | - David Martínez-Ramos
- Department of Surgery, Hospital General de Castellón, Av. Benicassim s/n, 12004, Castellón, Spain
| | - Javier Escrig-Sos
- Department of Surgery, Hospital General de Castellón, Av. Benicassim s/n, 12004, Castellón, Spain
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He KW, Sun JJ, Liu ZB, Zhuo PY, Ma QH, Liu ZY, Yu ZY. Prognostic significance of lymphatic vessel invasion diagnosed by D2-40 in Chinese invasive breast cancers. Medicine (Baltimore) 2017; 96:e8490. [PMID: 29095309 PMCID: PMC5682828 DOI: 10.1097/md.0000000000008490] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Lymphatic vessel invasion (LVI) is promising in determining prognosis and treatment strategies, but the application of LVI as a histopathological criterion in breast cancer patients especially those of different subgroups is controversial. This research aims to evaluate the prognostic value of LVI assessed by D2-40 not only in patients with early invasive breast cancer but also in lymph node-negative, lymph node-positive, luminal A-like, luminal B-like, HER2-enriched, and triple-negative subgroups.The study cohort included 255 patients with a median follow-up of 101 months. Immunohistochemical staining for D2-40 was performed to identify LVI.LVI was present in 64 (25.1%), 15 (12.1%), 49 (37.4%), 19 (20.9%), 23 (27.7%), 13 (31.7%), and 9 (22.5%), respectively, in the whole cohort, lymph node-negative, lymph node-positive, luminal A-like, luminal B-like, HER2-enriched, and triple-negative patients. LVI was associated with large tumor size (P = .04), high histological grade (P = .004), involved lymph node (P < .001), and high expression of Ki-67 (P = .003). No significant difference was found among patients with different subtypes and LVI status. The presence of LVI was significantly associated with adverse disease-free survival in the whole cohort (P < .001), lymph node-negative (P < .001), lymph node-positive (P < .001), luminal A-like (P < .001), and luminal B-like patients (P < .001) in both of the univariate and multivariate survival analysis.This study indicated that the presence of LVI stained by D2-40 provided independent prognostic information not only in the whole cohort but also in the subgroup of patients with lymph node-negative, lymph node-positive, luminal A-like, and luminal B-like diseases, which may make a case for routine clinical assessment of LVI using D2-40.
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Affiliation(s)
- Ke-Wen He
- School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Science, Jinan
- Department of Surgery, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Science, Jinan
| | - Ju-Jie Sun
- Department of Pathology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Science, Jinan
| | - Zai-Bo Liu
- Department of Surgery, Haiyang People's Hospital, Yantai, Shandong, China
| | - Pei-Ying Zhuo
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Science, Jinan
| | - Qing-Hua Ma
- Department of Surgery, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Science, Jinan
| | - Zhao-Yun Liu
- School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Science, Jinan
- Department of Surgery, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Science, Jinan
| | - Zhi-Yong Yu
- Department of Surgery, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Science, Jinan
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Wen J, Yang Y, Liu P, Ye F, Tang H, Huang X, Zhong S, Xie X. Development and validation of a nomogram for predicting survival on the base of modified lymph node ratio in breast cancer patients. Breast 2017; 33:14-22. [PMID: 28259045 DOI: 10.1016/j.breast.2017.01.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 01/24/2017] [Accepted: 01/27/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Axillary lymph node status is one of the most important prognostic factors in breast cancer and previous studies indicated that lymph node ratio (LNR) could better predict the outcome than the counting of positive lymph nodes. In the current study, we evaluated the prognostic effect of modified LNR in breast cancer patients. METHODS A total of 3339 breast cancer patients undergoing axillary lymph nodes dissection were enrolled and respectively analyzed. Seventy five percent of participants were randomly selected as training cohort and the remaining 25% were as validation cohort. Univariate and multivariate analyses were performed and the prognostic impact of mLNR was compared with pN staging. A prognostic nomogram was established and externally validated in the validation cohort. RESULT In multivariate analysis, both the mLNR and pN staging were independent prognostic factors for breast cancer patients, and the mLNR manifested superior discrimination power than the pN stages regardless of the total number of lymph nodes retrieved and the lymph node status. The nomogram was built including the identified independent prognostic factors and the calibration curves indicated optimal agreement between nomogram prediction and actual observation. The Concordance index (C-index) of the nomogram was statistically higher than that of the TNM system (0.747 vs. 0.711 in training cohort, 0.789 vs. 0.760 in validation cohort, both p < 0.05). CONCLUSION Modified LNR is an important prognostic parameter and can predict survival more accurately than pN staging. The novel nomogram could provide individual prediction for breast cancer patients and help clinicians in treatment option making and prognosis evaluation.
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Affiliation(s)
- Jiahuai Wen
- Department of Breast Oncology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Yanning Yang
- Department of Obstetrics and Gynecology, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Peng Liu
- Department of Breast Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Feng Ye
- Department of Breast Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Hailin Tang
- Department of Breast Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Xiaojia Huang
- Department of Breast Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Shaowen Zhong
- Department of Breast Oncology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Xiaoming Xie
- Department of Breast Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China.
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11
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Zhou R, Zhang J, Sun H, Liao Y, Liao W. Comparison of three lymph node classifications for survival prediction in distant metastatic gastric cancer. Int J Surg 2016; 35:165-171. [PMID: 27713088 DOI: 10.1016/j.ijsu.2016.09.096] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 08/31/2016] [Accepted: 09/26/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND The optimal lymph node (LN) classification system for prognostic assessment in distant metastatic gastric cancer (DMGC) patients who undergo LN dissection remains unclear. Therefore, we compared the prognostic performance of positive LN (PLN), LN ratio (LNR), and log odds of positive LNs (LODDS) in DMGC patients. METHODS A total of 1999 DMGC patients who underwent lymphadenectomy recorded in the Surveillance Epidemiology and End Results database from 2004 to 2012 were reviewed. RESULTS Univariate analyses showed that the PLN, LNR and LODDS systems were all significantly correlated with cancer-specific survival (CSS). However, only the LODDS classification remained an independent prognostic factor through the multivariate analysis. Furthermore, this classification could efficiently discriminate survival outcomes in patients within the same positive PLN category, as well as in patients with no positive node involvement. Both the LODDS and LNR classifications had better discriminatory ability, monotonicity, and homogeneity of prognostic stratification, as well as more accurate 1 or 2-year CSS prediction, than the PLN classification. The performances of the LNR and LODDS classifications were similar. Additionally, we found that inclusion of PORT carried a survival benefit across all LODDS intervals except the "LODDS ≤ -1.0" subgroup. CONCLUSION Our findings indicate that the LODDS classification is the most optimal system for prognostic assessment in DMGC patients. Incorporating LODDS into the staging system of DMGC patients will enable clinicians to more accurately predict prognosis and guide regional therapy regimen decisions in DMGC patients.
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Affiliation(s)
- Rui Zhou
- Department of Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Jingwen Zhang
- Department of Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Huiying Sun
- Department of Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Yulin Liao
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Wangjun Liao
- Department of Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
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12
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Lahat G, Lubezky N, Gerstenhaber F, Nizri E, Gysi M, Rozenek M, Goichman Y, Nachmany I, Nakache R, Wolf I, Klausner JM. Number of evaluated lymph nodes and positive lymph nodes, lymph node ratio, and log odds evaluation in early-stage pancreatic ductal adenocarcinoma: numerology or valid indicators of patient outcome? World J Surg Oncol 2016; 14:254. [PMID: 27687517 PMCID: PMC5041551 DOI: 10.1186/s12957-016-0983-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Accepted: 08/13/2016] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND We evaluated the prognostic significance and universal validity of the total number of evaluated lymph nodes (ELN), number of positive lymph nodes (PLN), lymph node ratio (LNR), and log odds of positive lymph nodes (LODDS) in a relatively large and homogenous cohort of surgically treated pancreatic ductal adenocarcinoma (PDAC) patients. METHODS Prospectively accrued data were retrospectively analyzed for 282 PDAC patients who had pancreaticoduodenectomy (PD) at our institution. Long-term survival was analyzed according to the ELN, PLN, LNR, and LODDS. RESULTS Of these patients, 168 patients (59.5 %) had LN metastasis (N1). Mean ELN and PLN were 13.5 and 1.6, respectively. LN positivity correlated with a greater number of evaluated lymph nodes; positive lymph nodes were identified in 61.4 % of the patients with ELN ≥ 13 compared with 44.9 % of the patients with ELN < 13 (p = 0.014). Median overall survival (OS) and 5-year OS rate were higher in N0 than in N1 patients, 22.4 vs. 18.7 months and 35 vs. 11 %, respectively (p = 0.008). Mean LNR was 0.12; 91 patients (54.1 %) had LNR < 0.3. Among the N1 patients, median OS was comparable in those with LNR ≥ 0.3 vs. LNR < 0.3 (16.7 vs. 14.1 months, p = 0.950). Neither LODDS nor various ELN and PLN cutoff values provided more discriminative information within the group of N1 patients. CONCLUSIONS Our data confirms that lymph node positivity strongly reflects PDAC biology and thus patient outcome. While a higher number of evaluated lymph nodes may provide a more accurate nodal staging, it does not have any prognostic value among N1 patients. Similarly, PLN, LNR, and LODDS had limited prognostic relevance.
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Affiliation(s)
- G Lahat
- Department of Surgery, Tel Aviv Sourasky Medical Center, 6th Weitzman St., Tel Aviv, Israel. .,Sackler Faculty of Medicine, The Nicholas and Elizabeth Cathedra of Experimental Surgery, Tel Aviv University, Tel Aviv, Israel.
| | - N Lubezky
- Department of Surgery, Tel Aviv Sourasky Medical Center, 6th Weitzman St., Tel Aviv, Israel.,Sackler Faculty of Medicine, The Nicholas and Elizabeth Cathedra of Experimental Surgery, Tel Aviv University, Tel Aviv, Israel
| | - F Gerstenhaber
- Department of Surgery, Tel Aviv Sourasky Medical Center, 6th Weitzman St., Tel Aviv, Israel.,Sackler Faculty of Medicine, The Nicholas and Elizabeth Cathedra of Experimental Surgery, Tel Aviv University, Tel Aviv, Israel
| | - E Nizri
- Department of Surgery, Tel Aviv Sourasky Medical Center, 6th Weitzman St., Tel Aviv, Israel.,Sackler Faculty of Medicine, The Nicholas and Elizabeth Cathedra of Experimental Surgery, Tel Aviv University, Tel Aviv, Israel
| | - M Gysi
- Sackler Faculty of Medicine, The Nicholas and Elizabeth Cathedra of Experimental Surgery, Tel Aviv University, Tel Aviv, Israel
| | - M Rozenek
- Sackler Faculty of Medicine, The Nicholas and Elizabeth Cathedra of Experimental Surgery, Tel Aviv University, Tel Aviv, Israel
| | - Y Goichman
- Department of Surgery, Tel Aviv Sourasky Medical Center, 6th Weitzman St., Tel Aviv, Israel.,Sackler Faculty of Medicine, The Nicholas and Elizabeth Cathedra of Experimental Surgery, Tel Aviv University, Tel Aviv, Israel
| | - I Nachmany
- Department of Surgery, Tel Aviv Sourasky Medical Center, 6th Weitzman St., Tel Aviv, Israel.,Sackler Faculty of Medicine, The Nicholas and Elizabeth Cathedra of Experimental Surgery, Tel Aviv University, Tel Aviv, Israel
| | - R Nakache
- Department of Surgery, Tel Aviv Sourasky Medical Center, 6th Weitzman St., Tel Aviv, Israel.,Sackler Faculty of Medicine, The Nicholas and Elizabeth Cathedra of Experimental Surgery, Tel Aviv University, Tel Aviv, Israel
| | - I Wolf
- Sackler Faculty of Medicine, The Nicholas and Elizabeth Cathedra of Experimental Surgery, Tel Aviv University, Tel Aviv, Israel.,Department of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - J M Klausner
- Department of Surgery, Tel Aviv Sourasky Medical Center, 6th Weitzman St., Tel Aviv, Israel.,Sackler Faculty of Medicine, The Nicholas and Elizabeth Cathedra of Experimental Surgery, Tel Aviv University, Tel Aviv, Israel
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13
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Unal D, Oguz A, Tasdemir A. Rate of metastasis in examined lymph nodes as a predictor of extracapsular extension in patients with axillary node-positive breast cancer. J NIPPON MED SCH 2015; 81:372-7. [PMID: 25744480 DOI: 10.1272/jnms.81.372] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The status of the axillary lymph nodes is an important factor in the prognosis and treatment of breast cancer. Extracapsular extension (ECE) is the spread of lymphatic tumor cells beyond the capsule of an axillary lymph node. Recent studies have demonstrated that ECE is a strongly unfavorable prognostic factor. OBJECTIVE In the present study, we investigated whether the rate of metastasis among examined lymph nodes can be used to predict ECE in patients with axillary node-positive breast cancer. METHODS The subjects were 95 women with axillary node-positive breast cancer. The numbers of lymph nodes removed (examined) and lymph nodes involved were recorded. The cut-off values, area under the curve, sensitivity, and specificity were calculated with the receiver operating characteristic curve technique for ability of the rate of metastasis to examined lymph nodes to predict ECE. RESULTS The rate of metastasis to examined lymph nodes was significantly greater in patients with ECE than in patients without ECE [0.57 (0.03-1.00) vs. 0.22 (0.04-1.00), respectively, p: 0.001]. Similarly, the presence of vascular infiltration was significantly higher in patients with ECE than in those without ECE [30 (73.2%) vs. 25 (47.2%) respectively, p: 0.010]. On the other hand, other variables did not differ between the groups (p>0.05). When the cut-off value was ≥0.23, the sensitivity and specificity of the rate of metastasis to examined lymph nodes were 80.49% and 55.56%, respectively. The area under the curve was 0.697 (95% confidence interval: 0.594-0.787, p: 0.004). CONCLUSION Our results suggest that rate of metastasis among examined lymph nodes is a predictor of ECE in patients with axillary node-positive breast cancer.
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Affiliation(s)
- Dilek Unal
- Department of Radiation Oncology, Kayseri Education and Research Hospital
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14
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A high lymph node ratio predicts loco-regional recurrence while microscopic N2 predicts survival after radiation therapy in pIIIA-N2 non-small cell lung cancer. ACTA ACUST UNITED AC 2015. [DOI: 10.1007/s13566-015-0196-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Xiao XS, Tang HL, Xie XH, Li LS, Kong YN, Wu MQ, Yang L, Gao J, Wei WD, Xie X. Metastatic axillary lymph node ratio (LNR) is prognostically superior to pN staging in patients with breast cancer--results for 804 Chinese patients from a single institution. Asian Pac J Cancer Prev 2014; 14:5219-23. [PMID: 24175804 DOI: 10.7314/apjcp.2013.14.9.5219] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The number of axillary lymph nodes involved and retrieved are important prognostic factors in breast cancer. The purpose of our study was to investigate whether the lymph node ratio (LNR) is a better prognostic factor in predicting disease-free survival (DFS) for breast cancer patients as compared with pN staging. The analysis was based on 804 breast cancer patients who had underwent axillary lymph node dissection between 1999 and 2008 in Sun Yat-Sen University Cancer Center. Optimal cutoff points of LNR were calculated using X-tile software and validated by bootstrapping. Patients were then divided into three groups (low-, intermediate-, and high-risk) according to the cutoff points. Predicting risk factors for relapse were performed according to Cox proportional hazards analysis. DFS was estimated using the Kaplan-Meier method and compared by the log-rank test. The 5-year DFS rate decreased significantly with increasing LNRs and pN. Univariate analysis found that the pT , pN, LNR, molecule type, HER2, pTNM stage and radiotherapy well classified patients with significantly different prognosis. By multivariate analysis, only LNR classification was retained as an independent prognostic factor. Furthermore, there was a significant prognostic difference among different LNR categories for pN2 category, but no apparent prognostic difference was seen between different pN categories in any LNR category. Therefore, LNR rather than pN staging is preferable in predicting DFS in node positive breast cancer patients, and routine clinical decision-making should take the LNR into consideration.
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Affiliation(s)
- Xiang-Sheng Xiao
- Department of Breast Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China E-mail :
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16
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Mohammed RAA, Menon S, Martin SG, Green AR, Paish EC, Ellis IO. Prognostic significance of lymphatic invasion in lymph node-positive breast carcinoma: findings from a large case series with long-term follow-up using immunohistochemical endothelial marker. Mod Pathol 2014; 27:1568-77. [PMID: 24762542 DOI: 10.1038/modpathol.2014.60] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 03/12/2014] [Indexed: 01/26/2023]
Abstract
The poor prognostic significance of lymphatic invasion (LI) in breast carcinoma (BC) as a whole and in lymph node (LN)-negative patients in particular has been recognized in several studies; however, its prognostic role in LN-positive patients is still questionable. Aim of the current study was to assess prognostic role of LI in LN-positive BC specimens. Sections from non-selected 557 LN-positive BC specimens were stained with antibody to podoplanin/D2-40. LI was identified and correlated with clinicopathological features and patients' outcome. Twenty-year overall survival (OS), disease-free interval (DFI), and development of distant metastasis (DM) or recurrence were known for all patients. LI was detected in 262/557 (47%) of specimens ranging from 1 to 350 lesion per tumor section. Its presence was associated with higher grade tumors (P<0.0001), negative hormonal receptors (P<0.0001), high HER-2 expression (P=0.006), and with increased number of positive LNs (P=0.019). In the whole LN-positive BC, presence of LI was a poor prognostic factor for OS, DFI, and development of DM both in univariate and in multivariate analysis. In further stratification of patients, LI was associated with poorer prognosis in patients with single positive LN and not in patients with >1 positive LN. In T1N1 stage, LI was highly associated with poor OS (P=0.002), DFI (P<0.0001), and DM (P<0.0001). In T2N1 patients, LI was associated only with poorer DFI (P=0.037) but not with death or DM. In the two former patient groups, LI lost significance in multivariate analysis. In conclusion, LI is a poor prognostic factor in LN-positive BC particularly for patients having single positive LN. LI therefore would add further prognostic significance when considered in treatment in those patients. We recommend incorporation of LI in breast carcinoma staging and in prognostic indices.
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Affiliation(s)
- Rabab A A Mohammed
- Department of Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Sindhu Menon
- Department of Histopathology, Royal Derby Hospital, Derby, UK
| | - Stewart G Martin
- Department of Clinical Oncology, University of Nottingham, University Hospitals, Nottingham, UK
| | - Andrew R Green
- Department of Histopathology, University of Nottingham, University Hospitals, Nottingham, UK
| | - Emma C Paish
- Department of Histopathology, University of Nottingham, University Hospitals, Nottingham, UK
| | - Ian O Ellis
- Department of Histopathology, University of Nottingham, University Hospitals, Nottingham, UK
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Lv P, Chen G, Zhang P. Log odds of positive lymph nodes are superior to other measures for evaluating the prognosis of non-small cell lung cancer. Thorac Cancer 2014; 5:570-5. [PMID: 26767054 DOI: 10.1111/1759-7714.12145] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 06/01/2014] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND To evaluate the ability of the log odds of positive lymph nodes to predict prognosis in patients with non-small cell lung cancer (NSCLC). METHODS Correlations between the log odds of positive lymph nodes, numbers of dissected lymph nodes, dissected lymph node stations, positive lymph nodes, positive lymph node ratio, and positive lymph node stations were retrospectively evaluated using Pearson correlation coefficients (r), survival analysis by Kaplan-Meier, Cox hazard ratio model, and log-rank tests. RESULTS The numbers of dissected lymph nodes, positive lymph nodes, dissected lymph node stations and positive lymph node stations significantly correlated with the log odds of positive lymph nodes (P < 0.001, P < 0.001, P = 0.002 and P < 0.001, respectively). The five-year survival ratio of postoperative patients with the log odds of positive lymph nodes <11.412 and >-1.412 were 63.9% and 32.5%, respectively (P < 0.001). According to multivariate analysis, age and log odds of positive lymph nodes are independent risk factors for overall survival (hazard ratio = 2.660, 95% confidence interval 2.114-3.346, P < 0.001). A new staging system featuring a combination of log odds of positive lymph nodes and a tumor node metastasis (TNM) staging system was established for predicting survival. CONCLUSION The log odds of positive lymph nodes are superior to the positive lymph node ratio and p-N-stage for predicting prognosis of NSCLC. A new staging system that combines log odds of positive lymph nodes and the current TNM staging system predicts prognosis more accurately than the TNM system alone.
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Affiliation(s)
- Peng Lv
- Department of Cardiothoracic Surgery, Tianjin Medical University General Hospital Tianjin, China
| | - Gang Chen
- Department of Thoracic Surgery, Provincial Hospital affiliated to Shandong University Jinan, China
| | - Peng Zhang
- Department of Cardiothoracic Surgery, Tianjin Medical University General Hospital Tianjin, China
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Jeyarajah DR, Khithani A, Siripurapu V, Liu E, Thomas A, Saad AJ. Lymph node retrieval in pancreaticoduodenectomy specimens: does educating the pathologist matter? HPB (Oxford) 2014; 16:263-6. [PMID: 23675739 PMCID: PMC3945852 DOI: 10.1111/hpb.12111] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Accepted: 03/14/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Many previous studies have suggested that the number of lymph nodes retrieved should serve as a benchmark for assessing the adequacy of the resection. The aim was to retrospectively observe the impact of nodal retrieval after educating the pathologist. METHODS Patients undergoing a pancreaticoduodenectomy (PD) between September 2005 and March 2009 were included in the study. The PDs performed between September 2005 and March 2008 were designated as Group A. The pathologists were educated regarding the importance of nodal counts in PD by the surgeon on the 1st April 2008. PDs performed between April 2008 and March 2009 were designated as Group B. RESULTS Ninety-eight PDs performed by a single surgeon (D.R.J.) for peri-ampullary malignancy were evaluated. The median number of lymph nodes retrieved in Group A was 11(3-32) nodes. The median number of lymph nodes retrieved in Group B was 22 (10-29) nodes (P < 0.001).The lymph node ratio (positive/total nodes), median number of positive nodes retrieved, and the node positivity (node positive compared to node negative) rate did not change. DISCUSSION A single intervention with the pathologists did impact the number of lymph nodes retrieved from PD specimens. However, the lymph node ratio and lymph node positivity rate remained unchanged. The pathologist is critical to nodal retrieval in PD, but the use of this lymph node number for benchmark of surgical adequacy may be simplistic.
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Affiliation(s)
- D Rohan Jeyarajah
- Department of Surgery, Methodist Dallas Medical CenterDallas, TX, USA,Department of Hepatopancreatobiliary Surgery, Methodist Dallas Medical CenterDallas, TX, USA,Department of Cancer Center, Methodist Dallas Medical CenterDallas, TX, USA,Correspondence D. Rohan Jeyarajah, Methodist Dallas Medical Center, 221 West Colorado Blvd, Pav 2, Suite 933, Dallas, Texas 75208, USA. Tel: +1 972 619 3500. Fax: +1 214 272 8985. E-mail:
| | - Amit Khithani
- Department of Surgery, Methodist Dallas Medical CenterDallas, TX, USA
| | - Veeraiah Siripurapu
- Department of Hepatopancreatobiliary Surgery, Methodist Dallas Medical CenterDallas, TX, USA
| | - Elizabeth Liu
- Department of Cancer Center, Methodist Dallas Medical CenterDallas, TX, USA
| | - Ashley Thomas
- Department of Cancer Center, Methodist Dallas Medical CenterDallas, TX, USA
| | - A Joe Saad
- Department of Pathology, Methodist Dallas Medical CenterDallas, TX, USA
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Wiznia LE, Lannin DR, Evans SB, Hofstatter EW, Horowitz NR, Killelea BK, Tsangaris TN, Chagpar AB. The number of lymph nodes dissected in breast cancer patients influences the accuracy of prognosis. Ann Surg Oncol 2013; 21:389-94. [PMID: 24132625 DOI: 10.1245/s10434-013-3308-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND Recent trials have suggested that axillary node dissection may not be warranted in some breast cancer patients with one to two positive nodes. Given that lymph node ratio (LNR; number of positive lymph nodes divided by the total examined) has been shown to be a significant prognostic factor, we sought to determine whether the number of nodes removed in this low risk population predicted survival. METHODS The National Cancer Database is a comprehensive clinical surveillance resource capturing 70% of newly diagnosed malignancies in the United States; 309,216 breast cancer patients diagnosed between 1998 and 2005, with tumors ≤5 cm and one to two positive nodes, formed the cohort of interest. RESULTS Median age at diagnosis was 57 (range 18-90) years. Median tumor size was 2 (range 0.1-5) cm; 215,382 patients (69.7%) had one positive node, and 93,834 (30.3%) had two. The median number of lymph nodes examined was 11 (range 1-84). Patients were categorized into low (≤0.2), medium (0.21-0.65), or high (>0.65) LNR groups, with 228,822 (74%), 55,797 (18%), and 24,597 (8%) patients in each of these categories, respectively. Median follow-up was 54.1 months. Median overall survival (OS) for low, intermediate, and high LNR was 66.1, 61.1, and 56.5 months, respectively (p < 0.001). In a Cox model controlling for clinicopathologic and therapy covariates, LNR category remained a significant predictor of OS (p < 0.001). CONCLUSIONS LNR is an independent predictor of OS in a low-risk population with one to two positive nodes and tumors ≤5 cm. Therefore, the number of lymph nodes excised may influence prognostic stratification.
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Affiliation(s)
- Lauren E Wiznia
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA,
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Fan Z, Li J, Wang T, Xie Y, Fan T, Lin B, Ouyang T. Level III axillary lymph nodes involvement in node positive breast cancer received neoadjuvant chemotherapy. Breast 2013; 22:1161-5. [PMID: 24080493 DOI: 10.1016/j.breast.2013.08.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Revised: 06/05/2013] [Accepted: 08/16/2013] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To investigate the incidence, associated factors and prognosis of level III node involvement for breast cancer with positive axillary lymph nodes after neoadjuvant chemotherapy. METHODS A consecutive series of 521 node positive T0-2 invasive breast cancer cases were included in this retrospective study. Axillary node metastases were proved by ultrasound guided needle biopsy (NB) if ultrasonographic abnormal node was detected or by sentinel node biopsy (SNB) if no abnormal node was detected. After 4 to 8 cycles of neoadjuvant chemotherapy (NCT), axillary lymph nodes dissection included level III lymph nodes were completed for each case. RESULTS The pathologic complete response rate of axillary nodes was 31.1% (90/289) in NB positive subgroup. The incidence of residual positive level III lymph nodes were 9.0% (47/521). Multivariate analysis showed that node NB positivity (OR = 2.212, 95% CI: 1.022-4.787, P = 0.044), clinical tumor size >2 cm before NCT (OR = 2.672, 95% CI: 1.170-6.098, P = 0.020), and primary tumor non-response to neoadjuvant chemotherapy (OR = 1.718, 95% CI: 1.232-2.396, P = 0.001) were independent predictors of level III lymph nodes positivity. At median follow-up time of 30 months, the distant disease-free survival (DDFS) rate of level III node positive group was much lower than that of level III negative group (p = 0.011). CONCLUSIONS About 9% of node positive T0-2 breast cancer will have residual positive node in level III region after neoadjuvant chemotherapy. Node positivity proved by NB, large tumor size, and primary tumor non-response to neoadjuvant chemotherapy are independent predictors of level III lymph nodes positivity.
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Affiliation(s)
- Zhaoqing Fan
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Breast Center, Peking University Cancer Hospital & Institute, No. 52, Fucheng Road, 100142 Beijing, China
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Lymph Node Ratio May Predict the Benefit of Postoperative Radiotherapy in Non–Small-Cell Lung Cancer. J Thorac Oncol 2013; 8:940-6. [DOI: 10.1097/jto.0b013e318292c53e] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Duraker N, Batı B, Çaynak ZC, Demir D. Lymph Node Ratio May Be Supplementary to TNM Nodal Classification in Node-positive Breast Carcinoma Based on the Results of 2,151 Patients. World J Surg 2013; 37:1241-8. [DOI: 10.1007/s00268-013-1965-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Wang X, Appleby DH, Zhang X, Gan L, Wang JJ, Wan F. Comparison of three lymph node staging schemes for predicting outcome in patients with gastric cancer. Br J Surg 2013; 100:505-14. [PMID: 23319421 DOI: 10.1002/bjs.9014] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2012] [Indexed: 12/14/2022]
Abstract
BACKGROUND Several node staging schemes have been proposed for gastric cancer. The optimal system remains controversial. METHODS Patients with gastric cancer were identified from the Surveillance, Epidemiology, and End Results (SEER) database, and a Chinese patient cohort was used for independent validation. The prognostic performance of three node staging schemes was compared, involving a number-based scheme (pN), ratio-based scheme (rN) and log odds of positive lymph nodes scheme (LODDS). RESULTS There were 12 443 patients in the SEER database and 866 in the Chinese cohort. LODDS provided better discriminatory capacity and higher predictive accuracy than either pN or rN, for patients with gastric cancer in both the SEER database and the Chinese cohort. The multivariable model using the LODDS classification was significantly more predictive than the pN classification. LODDS suffered much less from stage migration and was able efficiently to discriminate the heterogeneity for patients with no nodes involved or all nodes involved, whereas the pN and rN schemes could not. CONCLUSION LODDS showed a clear prognostic superiority over both pN and rN schemes. It could serve as an important reference for the tumour node metastasis (TNM) node classification.
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Affiliation(s)
- X Wang
- Department of Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, China
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Evaluation of lymph nodes in patients with colon cancer undergoing colon resection: a population-based study. World J Surg 2012; 36:1906-14. [PMID: 22484567 DOI: 10.1007/s00268-012-1568-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Though lymph node status may predict long-term outcome of patients with non-metastatic colon cancer, discordant findings exist among various expressions of lymph node status. The present study was designed to assess the prognostic value among these lymph node evaluations. METHODS The analysis was based on surgical patients with newly diagnosed colon adenocarcinoma registered in the Taiwan Cancer Database from 2003 to 2005. Exclusion criteria included those patients who had stage IV disease, those whose survival period was <1 month, or those whose lymph node information was unavailable. Studied variables included total number of lymph nodes (LNT), number of positive lymph nodes (LNP), number of negative lymph nodes (LNN), ratio of positive lymph nodes (LNR), and log odds of positive lymph nodes (LODDS). RESULTS Of 16,790 newly diagnosed colon cancer patients, there were 9,644 (65.4 ± 13.5 years; male 54.9 %) patients with non-metastatic disease who met the criteria. Correlation analyses for patients with stage III disease showed that LNR and LODDS were highly correlated, as were LNT and LNN. By the Cox proportional hazard model, LNT was prognostic of long-term survival in patients with stage II disease, while LNR and LNP were the most powerful prognosticators for patients with stage III disease (p < 0.001). Both the receiver operating characteristics curve analysis and area under the curve indicated that LNR had the best discriminating capability to predict 5-year survival (0.704, 0.700, and 0.709 for overall, disease-free, and disease-specific survival, respectively), followed by LODDS. CONCLUSIONS For patients undergoing resection for colon cancer, LNR, LODDS, and LNP are better prognostic factors for those with stage III disease than LNT is for patients with stage III disease.
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Tai P, Joseph K, El-Gayed A, Yu E. Long-term outcome of breast cancer patients with one to two nodes involved - application of nodal ratio. Breast J 2012; 18:542-8. [PMID: 23003004 DOI: 10.1111/tbj.12010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Nodal ratio (NR) is defined as the number of involved nodes to the number of nodes examined. There is limited information on the application of NR on population data. Previous reports in breast cancer generally analyzed one to three positive axillary nodes as a single group. This study investigates whether one to three positive axillary nodes is a homogeneous group in prognosis by comparing one to two positive nodes to three positive nodes. The population-based registry of a Canadian province from 1981 through 1995 was searched. As the reliability of nodal assessment depends on the number of nodes sampled, we also studied the subgroup of patients with greater than or equal to eight nodes dissected. Of a total of 5,996 breast cancer patients, 1187 had one to three positive axillary nodes. The 263 patients with three positive nodes compared to the 924 patients with one to two nodes fared worse with a significantly reduced cause-specific survival (CSS) and overall survival (OS). Patients with one to two positive nodes had similar CSS (p=0.31) and OS (p=0.63). Among those with greater than or equal to eight nodes dissected, there were 677 patients with one to two positive nodes. CSS and OS were not significantly different between one versus two positive nodes (p=0.16 and 0.34, respectively), but with NR, the corresponding p values were 0.0068 and 0.08, respectively. The cutoff value of NR 0.15 was found to be most useful and confirmed by the validation dataset. NR is able to segregate patients better than the absolute number of positive nodes used in the current staging system. NR should be incorporated into the staging system.
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Affiliation(s)
- Patricia Tai
- Department of Radiation Oncology, Allan Blair Cancer Centre, University of Saskatchewan, Canada.
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Duraker N, Demir D, Bati B, Yilmaz BD, Bati Y, Caynak ZC, Sobutay E. Survival Benefit of Post-mastectomy Radiotherapy in Breast Carcinoma Patients with T1-2 Tumor and 1-3 Axillary Lymph Node(s) Metastasis. Jpn J Clin Oncol 2012; 42:601-8. [DOI: 10.1093/jjco/hys052] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Qiu MZ, Qiu HJ, Wang ZQ, Ren C, Wang DS, Zhang DS, Luo HY, Li YH, Xu RH. The tumor-log odds of positive lymph nodes-metastasis staging system, a promising new staging system for gastric cancer after D2 resection in China. PLoS One 2012; 7:e31736. [PMID: 22348125 PMCID: PMC3279377 DOI: 10.1371/journal.pone.0031736] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Accepted: 01/12/2012] [Indexed: 02/07/2023] Open
Abstract
Background In this study, we established a hypothetical tumor-lodds-metastasis (TLM) and tumor-ratio-metastasis (TRM) staging system. Moreover, we compared them with the 7th edition of American Joint Committee on Cancer tumor-nodes-metastasis (AJCC TNM) staging system in gastric cancer patients after D2 resection. Methods A total of 1000 gastric carcinoma patients receiving treatment in our center were selected for the analysis. Finally, 730 patients who received D2 resection were retrospectively studied. Patients were staged using the TLM, TRM and the 7th edition AJCC TNM system. Survival analysis was performed with a Cox regression model. We used two parameters to compare the TNM, TRM and TLM staging system, the −2log likelihood and the hazard ratio. Results The cut points of lymph node ratio (LNR) were set as 0, 0–0.3, 0.3–0.6, 0.6–1.0. And for the log odds of positive lymph nodes (LODDS), the cut points were established as≤−0.5, −0.5-0, 0-0.5, >0.5. There were significant differences in survival among patients in different LODDS classifications for each pN or LNR groups. When stratified by the LODDS classifications, the prognosis was highly homologous between those in the according pN or LNR classifications. Multivariate analysis showed that TLM staging system was better than the TRM or TNM system for the prognostic evaluation. Conclusions The TLM system was superior to the TRM or TNM system for prognostic assessment of gastric adenocarcinoma patients after D2 resection.
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Affiliation(s)
- Miao-zhen Qiu
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Hui-juan Qiu
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Department of Traditional Chinese Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Zhi-qiang Wang
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Chao Ren
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - De-shen Wang
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Dong-sheng Zhang
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Hui-yan Luo
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Yu-hong Li
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Rui-hua Xu
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China
- * E-mail:
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Duraker N, Batı B, Demir D, Caynak ZC. Prognostic Significance of the Number of Removed and Metastatic Lymph Nodes and Lymph Node Ratio in Breast Carcinoma Patients with 1-3 Axillary Lymph Node(s) Metastasis. ISRN ONCOLOGY 2011; 2011:645450. [PMID: 22091427 PMCID: PMC3195782 DOI: 10.5402/2011/645450] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Accepted: 07/17/2011] [Indexed: 12/28/2022]
Abstract
We evaluated the prognostic significance of lymph node ratio (LNR), number of metastatic lymph nodes divided by number of removed nodes in 924 breast carcinoma patients with 1-3 metastatic axillary lymph node(s). The most significant LNR threshold value separating patients in low- and high-risk groups with significant survival difference was 0.20 for disease-free survival (P < 0.001), 0.30 for locoregional recurrence-free survival (P < 0.001), and 0.15 for distant metastasis-free survival (P < 0.001), and the patients with lower LNR had better survival. All three LNR threshold values had independent prognostic significance in Cox analysis (P < 0.001 for all three of them). In conclusion, LNR is a useful tool in separating breast carcinoma patients with 1-3 metastatic lymph node(s) into low- and high-risk prognostic groups.
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Affiliation(s)
- Nüvit Duraker
- Third Department of Surgery, SB Okmeydanı Training and Research Hospital, Istanbul, Turkey
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Song YJ, Shin SH, Cho JS, Park MH, Yoon JH, Jegal YJ. The role of lymphovascular invasion as a prognostic factor in patients with lymph node-positive operable invasive breast cancer. J Breast Cancer 2011; 14:198-203. [PMID: 22031801 PMCID: PMC3200515 DOI: 10.4048/jbc.2011.14.3.198] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Accepted: 08/12/2011] [Indexed: 11/30/2022] Open
Abstract
Purpose Lymphovascular invasion (LVI) is an important prognostic factor in patients with lymph node-negative patients with invasive breast cancer. However, the prognostic value of LVI it is unclear and controversial about its prognostic value in patients with lymph node-positive breast cancer patients. So, we report the an analysis of the prognostic significance of LVI in a large cohort study of patients with lymph node-positive patients with invasive breast cancer. Methods We retrospectively reviewed 967 patients with invasive breast cancer that had undergone surgical treatment at our hospital, from January 2004 to December 2007. Among these thempatients, 349 patients with lymph node-positive breast cancer patients are were included in this study. We evaluated clinical and pathological data in these patients, we compared with 5-year overall survival and disease-free survival between an LVI-present group and an LVI-absent group. Results The median follow-up was 48 months (range, 12-78 months), and the mean age of the patients was 48 years (range, 23-78 years). LVI was present in 192 patients (55%) of with tumors and was associated with age ≤40 years (p=0.009), high histologichistological grade (p=0.007), estrogen receptor status (p=0.001), tumor size ≥2 cm (p<0.001), and number of involved lymph nodes (p<0.001), but not with progesterone receptor status, HER2 status, p53 status, or tumor multiplicity. LVI was a significant independent prognostic factor for disease-free survival (p<0.001) and overall survival (p=0.006). By multivariate analysis revealed that LVI (p=0.003), number of involved lymph nodes (≥4; p=0.005), and high histological grade (II and III; p=0.02) was were an independent significant predictors of disease-free survival and overall survival in the whole group of patients. Conclusion In this case, we demonstrated that LVI is a significant predictor of poor prognosis in patients with lymph node-positive patients with primary invasive breast cancer, LVI is a significant predictive predictor value of poor prognosis. So, LVI should be considered in the therapeutic strategy as a decision making tool in the adjuvant chemotherapy setting.
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Affiliation(s)
- Young Ju Song
- Department of Surgery, Chonnam National University Medical School, Gwangju, Korea
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Validation of the prognostic value of lymph node ratio in patients with cutaneous melanoma: A population-based study of 8,177 cases. Surgery 2011; 150:83-90. [DOI: 10.1016/j.surg.2011.02.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2010] [Accepted: 02/17/2011] [Indexed: 11/22/2022]
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Tai P, Joseph KJ, Yu E. Issues related to sentinel lymph node assessment in the management of breast cancer-what are relevant in pathology reports? PATHOLOGY RESEARCH INTERNATIONAL 2011; 2011:504940. [PMID: 21559203 PMCID: PMC3090134 DOI: 10.4061/2011/504940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/12/2010] [Accepted: 01/19/2011] [Indexed: 11/20/2022]
Abstract
Most cancer centers now perform sentinel node (SN) biopsies. The limited number of SNs sampled compared with an axillary dissection has allowed more comprehensive lymph node analysis resulting in increased detection of micrometastases. Many node-negative cases are now reclassified as micrometastatic. Recent research on SN biopsy focuses on whether axillary dissection is always necessary when the SN is positive. Some subgroups of patients have a higher risk of more nodal metastases when completion axillary dissections were performed. This paper summarizes the different studies and examines what are the clinically relevant items to report on SN node pathology: volume or size of nodal metastasis, location within the node, extranodal extension, number of involved SN(s) and non-SN(s), total number of SN, and total number of nodes on axillary dissection, if performed.
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Affiliation(s)
- Patricia Tai
- Department of Radiation Oncology, Allan Blair Cancer Center, SK, Canada S4T 7T1
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Ragage F, Debled M, MacGrogan G, Brouste V, Desrousseaux M, Soubeyran I, de Lara CT, Mauriac L, de Mascarel I. Is it useful to detect lymphovascular invasion in lymph node-positive patients with primary operable breast cancer? Cancer 2010; 116:3093-101. [PMID: 20564641 DOI: 10.1002/cncr.25137] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Lymphovascular invasion (LVI) is a widely recognized prognostic factor in lymph node-negative breast cancers. However, there are only limited and controversial data about its prognostic significance in lymph node-positive patients. METHODS Among 931 patients operated on and monitored at the authors' institution for an invasive breast carcinoma between 1989 and 1992, all 374 lymph node-positive breast cancers entered the study (median follow-up, 126 months). RESULTS LVI was present in 46% of tumors and was associated with age < or = 40 years (P = .02), high histological grade (P = .01), and negative estrogen receptor status (P = .032), but not with tumor size, number of involved lymph nodes, or HER-2/neu status. LVI was an independent prognostic factor for distant metastases (P = .002). Furthermore, in HER-2/neu-negative/hormone receptor-positive (n = 287) tumors, the number of independent prognostic factors (LVI, age, histological grade, number of involved lymph nodes, and tumor size) was associated with a 5-years metastasis-free survival ranging from 100% if no factors (n = 25) to 89% +/- 2% if 1 or 2 factors (n = 186) and 67% +/- 6 if 3, 4, or 5 factors (n = 76) were present (P < .001). CONCLUSIONS LVI is an independent prognostic factor in lymph node-positive breast cancer and merits further prospective investigations as a decision tool in the adjuvant chemotherapy setting.
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Affiliation(s)
- Florence Ragage
- Department of Pathology, Bergonié Institute, Regional Cancer Center, Bordeaux Cedex, France
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Truong PT, Lesperance M, Li KH, MacFarlane R, Speers CH, Chia S. Micrometastatic Node-Positive Breast Cancer: Long-Term Outcomes and Identification of High-Risk Subsets in a Large Population-Based Series. Ann Surg Oncol 2010; 17:2138-46. [DOI: 10.1245/s10434-010-0954-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2009] [Indexed: 11/18/2022]
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Mersin H, Yildirim E, Berberoglu U, Gulben K. Triple negative phenotype and N-ratio are important for prognosis in patients with stage IIIB non-inflammatory breast carcinoma. J Surg Oncol 2010; 100:681-7. [PMID: 19798691 DOI: 10.1002/jso.21411] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVES The aim is to evaluate novel prognostic factors such as triple negative (TN) phenotype and ratio between positive nodes and total dissected lymph nodes (N-ratio) in stage IIIB breast carcinoma patients. METHODS In this retrospective study, primary endpoints were local recurrence (LR), distant recurrence (DR), and overall survival (OS). Univariate and multivariate prognostic factor analyses were carried out using Cox and Kaplan-Meier methods in the data of 185 patients. RESULTS The median observation time was 36 (range 16-86) months. Pathological tumor size (continuous [cont.], P = 0.002; Hazard ratio [HR], 1.2; 95% confidence interval [CI], 1.1-1.3) and N-ratio (cont., P < 0.0001; HR, 1.02; CI, 1.01-1.03) were strongly associated with LR. Tumor phenotype (triple vs. non-triple, P = 0.002; HR, 2.6; CI, 1.4-4.7), N-ratio (cont., P = 0.01; HR, 1.02; CI, 1.01-1.03) and pathological tumor size (cont., P = 0.003; HR, 1.2; CI, 1.1-1.3) for DR, and also tumor phenotype (triple vs. non-triple, P < 0.0001; HR, 3.7; CI, 1.8-7.5), N-ratio (cont., P = 0.03; HR, 1.02; CI, 1.01-1.03) and pathological tumor size (cont., P = 0.006; HR, 1.3; CI, 1.2-1.4) for OS were the most important prognostic factors. CONCLUSIONS N-Ratio and TN phenotype were the most important prognostic factors for stage IIIB breast carcinoma patients.
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Affiliation(s)
- Hakan Mersin
- Department of Surgery, Ankara Oncology Training and Research Hospital, Ankara, Turkey.
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Vinh-Hung V, Nguyen NP, Cserni G, Truong P, Woodward W, Verkooijen HM, Promish D, Ueno NT, Tai P, Nieto Y, Joseph S, Janni W, Vicini F, Royce M, Storme G, Wallace AM, Vlastos G, Bouchardy C, Hortobagyi GN. Prognostic value of nodal ratios in node-positive breast cancer: a compiled update. Future Oncol 2009; 5:1585-603. [PMID: 20001797 DOI: 10.2217/fon.09.129] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
The number of positive axillary nodes is a strong prognostic factor in breast cancer, but is affected by variability in nodal staging technique yielding varying numbers of excised nodes. The nodal ratio of positive to excised nodes is an alternative that could address this variability. Our 2006 review found that the nodal ratio consistently outperformed the number of positive nodes, providing strong arguments for the use of nodal ratios in breast cancer staging and management. New evidence has continued to accrue confirming the prognostic significance of nodal ratios in various worldwide population settings. This review provides an updated summary of available data, and discusses the potential application of the nodal ratio to breast cancer staging and prognostication, its role in the context of modern surgical techniques such as sentinel node biopsy, and its potential correlations with new biologic markers such as circulating tumor cells and breast cancer stem cells.
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Prognostic Significance of Histology and Positive Lymph Node Involvement Following Radical Hysterectomy in Carcinoma of the Cervix. Am J Clin Oncol 2009; 32:411-6. [DOI: 10.1097/coc.0b013e31819142dc] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Vaccaro CA, Im V, Rossi GL, Quintana GO, Benati ML, Perez de Arenaza D, Bonadeo FA. Lymph node ratio as prognosis factor for colon cancer treated by colorectal surgeons. Dis Colon Rectum 2009; 52:1244-50. [PMID: 19571700 DOI: 10.1007/dcr.0b013e3181a65f0b] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE This study was designed to assess the prognostic value of the lymph node ratio in patients with colon cancer treated by colorectal specialists. METHODS Three hundred and sixty-two Stage III consecutive cases were analyzed based on quartiles: lymph node ratio 1 (>0 and <0.06); lymph node ratio 2 (between 0.06 and 0.12); lymph node ratio 3 (>0.12 and <0.25); lymph node ratio 4 (>or=0.25). RESULTS Disease-free survival rates were: lymph node ratio 1, 75.5%; lymph node ratio 2, 74.2%; lymph node ratio 3, 73.2%; and lymph node ratio 4, 40.1%. Similar differences were observed for cancer-specific and overall survival rates. Cases with lymph node ratio >or=0.25 had higher hazard ratios than cases with lymph node ratio <0.25 in terms of disease-free survival (2.8, P < 0.001), cancer-specific survival (3.1, P = 0.0001), and overall survival (2.2, P = 0.0001). The hazard ratio of cases with up to three positive nodes and lymph node ratios >or=0.25 was higher than that of cases with up to three positive nodes and lymph node ratios <0.25 in terms of disease-free survival (3.1, P = 0.003), cancer-specific survival (3.5, P = 0.002), and overall survival (2.4, P = 0.02). Similar differences were found for cases with more than three positive nodes. Lymph node ratio, but not number of positive nodes, had independent prognostic value in multivariate analysis. No interaction between these two variables was found. CONCLUSION A lymph node ratio >or=0.25 was an independent prognostic factor in Stage III colon adenocarcinoma regardless of the number positive nodes. It modified outcomes predicted by the current staging system.
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Affiliation(s)
- Carlos A Vaccaro
- Section of Colorectal Surgery, Hospital Italiano de Buenos Aires, Ciudad de Buenos Aires, Argentina.
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The value of level III clearance in patients with axillary and sentinel node positive breast cancer. Ann Surg 2009; 249:834-9. [PMID: 19387317 DOI: 10.1097/sla.0b013e3181a40821] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The value of level III axillary clearance is contentious, with great variance worldwide in the extent and levels of clearance performed. OBJECTIVE To determine rates of level III positivity in patients undergoing level I-III axillary clearance, and identify which patients are at highest risk of involved level III nodes. METHODS From a database of 2850 patients derived from symptomatic and population-based screening service, 1179 patients who underwent level I-III clearance between the years 1999-2007 were identified. The pathology, surgical details, and prior sentinel nodes biopsies of patients were recorded. RESULTS Eleven hundred seventy nine patients had level I-III axillary clearance. Of the patients, 63% (n = 747) were node positive. Of patients with node positive disease, 23% (n = 168) were level II positive and 19% (n = 141) were level III positive. Two hundred fifty patients had positive sentinel node biopsies prior to axillary clearance. Of these, 12% (n = 30) and 9% (n = 22) were level II and level III positive, respectively. On multivariate analysis, factors predictive of level III involvement in patients with node positive disease were tumor size (P < 0.001, OR = 1.36; 95% CI: 1.2-1.5), invasive lobular disease (P < 0.001, OR = 3.6; 95% CI: 1.9-6.95), extranodal extension (P < 0.001, OR = 0.27; 95% CI: 0.18-0.4), and lymphovascular invasion (P = 0.04, OR = 0.58; 95% CI: 0.35-1). Lobular invasive disease (P = 0.049, OR = 4.1; 95% CI: 1-16.8), extranodal spread (P = 0.003, OR = 0.18; 95% CI: 0.06-0.57), and having more than one positive sentinel node (P = 0.009, OR = 4.9; 95% CI: 1.5-16.1) were predictive of level III involvement in patients with sentinel node positive disease. CONCLUSION Level III clearance has a selective but definite role to play in patients who have node positive breast carcinoma. Pathological characteristics of the primary tumor are of particular use in identifying those who are at various risk of level III nodal involvement.
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Abstract
BACKGROUND Lymph node ratio (LNR) has been associated with long-term survival in patients with pancreatic adenocarcinoma; however, this has not been demonstrated in other periampullary malignancies. The purpose of this study was to determine if LNR is associated with survival in other periampullary malignancies. METHODS A retrospective review of a prospective database of 522 pancreaticoduodenectomies (PDs) performed between 1988 and 2007 was undertaken. Clinicopathologic data were collected, and LNR was calculated. Patients with positive lymph node (LN) status were placed into the following groups: (1) LNR = 0; (2) LNR < or =0.2; (3) LNR < or =0.4; and (4) LNR >0.4. RESULTS Of the 364 malignancies identified, there were 219 (60%) pancreatic adenocarcinomas, 36 (10%) duodenal adenocarcinomas, 75 (21%) ampullary adenocarcinomas, and 35 (10%) cholangiocarcinomas. Positive LN status affected patient survival in all malignancies studied. Increasing LNR is associated with decreased survival in PA (P = .03) and AA (P = .04). CONCLUSIONS Positive LN status in all patients with periampullary malignancies is associated with worse survival rates than in those with no evidence of disease. LNR is inversely associated with survival rates in pancreatic and ampullary adenocarcinoma patients.
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Hurtuk MG, Hughes C, Shoup M, Aranha GV. Does lymph node ratio impact survival in resected periampullary malignancies? Am J Surg 2009; 197:348-52. [PMID: 19245913 DOI: 10.1016/j.amjsurg.2008.11.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2008] [Revised: 11/12/2008] [Accepted: 11/12/2008] [Indexed: 12/23/2022]
Abstract
BACKGROUND Lymph node ratio (LNR) has been associated with long-term survival in patients with pancreatic adenocarcinoma; however, this has not been demonstrated in other periampullary malignancies. The purpose of this study was to determine if LNR is associated with survival in other periampullary malignancies. METHODS A retrospective review of a prospective database of 522 pancreaticoduodenectomies (PDs) performed between 1988 and 2007 was undertaken. Clinicopathologic data were collected, and LNR was calculated. Patients with positive lymph node (LN) status were placed into the following groups: (1) LNR = 0; (2) LNR < or =0.2; (3) LNR < or =0.4; and (4) LNR >0.4. RESULTS Of the 364 malignancies identified, there were 219 (60%) pancreatic adenocarcinomas, 36 (10%) duodenal adenocarcinomas, 75 (21%) ampullary adenocarcinomas, and 35 (10%) cholangiocarcinomas. Positive LN status affected patient survival in all malignancies studied. Increasing LNR is associated with decreased survival in PA (P = .03) and AA (P = .04). CONCLUSIONS Positive LN status in all patients with periampullary malignancies is associated with worse survival rates than in those with no evidence of disease. LNR is inversely associated with survival rates in pancreatic and ampullary adenocarcinoma patients.
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Affiliation(s)
- Michael G Hurtuk
- Department of Surgery, Division of Surgical Oncology, Loyola University Medical Center, Maywood, IL, USA
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Vinh-Hung V, Verkooijen HM, Fioretta G, Neyroud-Caspar I, Rapiti E, Vlastos G, Deglise C, Usel M, Lutz JM, Bouchardy C. Lymph node ratio as an alternative to pN staging in node-positive breast cancer. J Clin Oncol 2009; 27:1062-8. [PMID: 19164210 DOI: 10.1200/jco.2008.18.6965] [Citation(s) in RCA: 178] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE In the current pTNM classification system, nodal status of breast cancer is based on the number of involved lymph nodes and does not account for the total number of lymph nodes removed. In this study, we assessed the prognostic value of the lymph node ratio (LNR; ie, ratio of positive over excised lymph nodes) as compared with pN staging and determined its optimal cutoff points. PATIENTS AND METHODS From the Geneva Cancer Registry, we identified all women diagnosed with node-positive breast cancer between 1980 and 2004 (n = 1,829). The prognostic value of LNRs was calculated for values ranging from 0.05 to 0.95 by Cox regression analysis and validated by bootstrapping. Based on maximum likelihood, we identified cutoff points classifying women into low-, intermediate-, and high-risk LNR groups. RESULTS Optimal cutoff points classified patients into low- (< or = 0.20), intermediate- (> 0.20 and < or = 0.65), and high-risk (> 0.65) LNR groups, corresponding to 10-year disease-specific survival rates of 75%, 63%, and 40%, and adjusted mortality risks of 1 (reference), 1.78 (95% CI, 1.46 to 2.18), and 3.21 (95% CI, 2.54 to 4.06), respectively. In contrast to LNR risk categories, survival curves of pN2 and pN3 crossed after 15 years, and their adjusted mortality risks showed overlapping CIs: 2.07 (95% CI, 1.69 to 2.53) and 2.84 (95% CI, 2.23 to 3.61), respectively. CONCLUSION LNR predicts survival after breast cancer more accurately than pN classification and should be considered as an alternative to pN staging.
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Affiliation(s)
- Vincent Vinh-Hung
- Oncology Center, Universitair Ziekenhuis Brussel, 101 Laarbeeklaan, 1090 Jette, Belgium.
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The prognostic superiority of log odds of positive lymph nodes in stage III colon cancer. J Gastrointest Surg 2008; 12:1790-6. [PMID: 18709510 DOI: 10.1007/s11605-008-0651-3] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2008] [Accepted: 07/28/2008] [Indexed: 01/31/2023]
Abstract
BACKGROUND Literature showed that lymph node ratio (LNR) and total number of lymph nodes (TNODS) are independent prognostic factors in node-positive colon cancer. Our study assesses the prognostic superiority of the log odds of positive lymph nodes (LODDS) in the same patient population. MATERIAL AND METHODS A total of 24,477 stage III colon cancer cases from the SEER registry were reviewed. Patients were categorized based on LNR into LNR1 to LNR4, according to cutoff points 0.07, 0.25, and 0.50, and based on LODDS into LODDS1 to LODDS5, according to cutoff points -2.2, -1.1, 0, and 1.1. The relative risk (RR), and 95% confidence interval (CI) were evaluated using the method of Kaplan-Meier and Cox model. RESULTS Patients with LNR4 could be classified into LODDS4 (61.4%) and LODDS5 (38.4%). The survival in these two groups was significantly different (5-year survival, 33.5% vs. 23.3%, p < 0.0001). Univariate analysis showed that the higher LNR (RR = 3.45, 95% CI = 3.26-3.66) or low TNODS (RR = 0.99, 95% CI = 0.986-0.99) was significantly associated with poor survival. However, after adjusting for LODDS status, the association did not appear to be significant (LNR, RR = 0.90, 95% CI = 0.65-1.24, p = 0.52; TNODS, RR = 1.001, 95% CI = 0.997-1.005, p = 0.54). CONCLUSION Colon cancer patients with LNR4 disease represent a heterogeneous group. The previously reported prognostic association of TNODS and LNR and outcome of stage III disease were confounded by LODDS.
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Piroth MD, Pinkawa M, Gagel B, Stanzel S, Asadpour B, Eble MJ. Sequencing chemotherapy and radiotherapy in locoregional advanced breast cancer patients after mastectomy - a retrospective analysis. BMC Cancer 2008; 8:114. [PMID: 18433485 PMCID: PMC2377278 DOI: 10.1186/1471-2407-8-114] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2007] [Accepted: 04/23/2008] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Combined chemo- and radiotherapy are established in breast cancer treatment. Chemotherapy is recommended prior to radiotherapy but decisive data on the optimal sequence are rare. This retrospective analysis aimed to assess the role of sequencing in patients after mastectomy because of advanced locoregional disease. METHODS A total of 212 eligible patients had a stage III breast cancer and had adjuvant chemotherapy and radiotherapy after mastectomy and axillary dissection between 1996 and 2004. According to concerted multi-modality treatment strategies 86 patients were treated sequentially (chemotherapy followed by radiotherapy) (SEQgroup), 70 patients had a sandwich treatment (SW-group) and 56 patients had simultaneous chemoradiation (SIM-group) during that time period. Radiotherapy comprised the thoracic wall and/or regional lymph nodes. The total dose was 45-50.4 Gray. As simultaneous chemoradiation CMF was given in 95.4% of patients while in sequential or sandwich application in 86% and 87.1% of patients an anthracycline-based chemotherapy was given. RESULTS Concerning the parameters nodal involvement, lymphovascular invasion, extracapsular spread and extension of the irradiated region the three treatment groups were significantly imbalanced. The other parameters, e.g. age, pathological tumor stage, grading and receptor status were homogeneously distributed. Looking on those two groups with an equally effective chemotherapy (EC, FEC), the SEQ- and SW-group, the sole imbalance was the extension of LVI (57.1 vs. 25.6%, p < 0.0001).5-year overall- and disease free survival were 53.2%/56%, 38.1%/32% and 64.2%/50%, for the sequential, sandwich and simultaneous regime, respectively, which differed significantly in the univariate analysis (p = 0.04 and p = 0.03, log-rank test). Also the 5-year locoregional or distant recurrence free survival showed no significant differences according to the sequence of chemo- and radiotherapy. In the multivariate analyses the sequence had no independent impact on overall survival (p = 0.2) or disease free survival (p = 0.4). The toxicity, whether acute nor late, showed no significant differences in the three groups. The grade III/IV acute side effects were 3.6%, 0% and 3.5% for the SIM-, SW- and SEQ-group. By tendency the SIM regime had more late side effects. CONCLUSION No clear advantage can be stated for any radio- and chemotherapy sequence in breast cancer therapy so far. This could be confirmed in our retrospective analysis in high-risk patients after mastectomy. The sequential approach is recommended according to current guidelines considering a lower toxicity.
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Affiliation(s)
- Marc D Piroth
- Department of Radiation Oncology, RWTH Aachen University Hospital, Aachen, Germany
| | - Michael Pinkawa
- Department of Radiation Oncology, RWTH Aachen University Hospital, Aachen, Germany
| | - Bernd Gagel
- Department of Radiation Oncology, RWTH Aachen University Hospital, Aachen, Germany
| | - Sven Stanzel
- Institute of Medical Statistics, RWTH Aachen University Hospital, Aachen, Germany
| | - Branka Asadpour
- Department of Radiation Oncology, RWTH Aachen University Hospital, Aachen, Germany
| | - Michael J Eble
- Department of Radiation Oncology, RWTH Aachen University Hospital, Aachen, Germany
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Gorgulu S, Can MF, Yagci G, Sahin M, Tufan T. Extracapsular extension is associated with increased ratio of metastatic to examined lymph nodes in axillary node-positive breast cancer. Clin Breast Cancer 2007; 7:796-800. [PMID: 18021482 DOI: 10.3816/cbc.2007.n.042] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Extracapsular extension of nodal tumor cells, although it is not a parameter of staging, has recently been shown to be correlated with the high number of metastatic lymph nodes in patients with axillary-positive breast cancer. It is suggested that the use of involved/examined lymph node ratio instead of the number of metastatic lymph nodes in axillary evaluation would obtain standardized prognostic data for patient management. This study investigated the association of the extracapsular extension with the lymph node ratio in a node-positive group of patients. PATIENTS AND METHODS Medical records of 170 patients with positive axillary status were retrospectively reviewed. Of these, 54 were extracapsular extension positive, and the remaining were extracapsular extension negative. A comparison was made between extracapsular extension-positive and extracapsular extension-negative groups with respect to some potential prognostic indicators. RESULTS Number of metastatic lymph nodes, number of examined lymph nodes, and involved/examined lymph node ratio were found to be significantly higher in patients with a presence of extracapsular extension. CONCLUSION The results suggest that the presence of extracapsular extension might force physicians to perform more aggressive adjuvant therapies and that the extracapsular extension could be a valuable parameter in the management of breast cancer because it has a strong relationship with the proven prognostic factors.
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Affiliation(s)
- Semih Gorgulu
- Department of General Surgery, Gulhane School of Medicine, Ankara, Turkey
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