The purpose of this study was to evaluate the prognostic value of nodal ratio compared to the absolute number of positive lymph nodes in patients with ≥4 positives nodes early-stage breast cancer.
Between 2010-2015, we identified 111 patients with early-stage pN2-N3 breast cancer. All patients were treated with curative intent and had at least 8 resected lymph nodes. We calculated nodal ratio (NR=positive over excised lymph nodes) for each patient. Several prognostic factors were evaluated. The Cox proportional hazard model was used to evaluate the prognostic significance for relapse-free survival and overall survival.
Median age was 50 years old. Lymph node involvement was pN2 in 61.3% of cases and pN3 in 38.7% of cases. Median tumor size was 46 mm. Hormonal receptors were positive in 73.9% of cases. Her2 Neu was overexpressed in 32.4% of cases. Relapse rate was 34.2% (locoregional 36.2%, metastatic in 63.8%). After a median follow-up of 44 months, we did not observe any difference in terms of relapse rate (30% vs 40%, p = 0.19), time to relapse (25 months, p = 0.94), relapse-free survival and overall survival according to absolute number of involved lymph nodes (pN2 vs pN3 groups). NR ≥ 60% was significantly correlated with relapse rate (24% vs 53%, p = 0.02). There was no impact of NR on time to relapse (24 vs 26 months p = 0.81). In univariate analysis we observed a significant difference in 5-year relapse-free survival between patients with NR < 60% vs NR ≥ 60% (59% vs 49%, p = 0.04). In multivariate analysis including: grade, hormonal receptors, HER2, Ki67, we observed that NR was as an independent prognostic factor for relapse-free survival. There was no impact on overall survival.
NR ≥ 60% predicted relapse-free survival better than the absolute number of involved lymph nodes in pN2 and pN3 early-stage breast cancer.
Clinical trial identification
Legal entity responsible for the study
Abderrahmen Mami Hospital.
Has not received any funding.
All authors have declared no conflicts of interest.