In the past decade, previous studies have suggested that lymph node ratio (LNR, ratio of involved over dissected lymph nodes) was a superior predictor for survival compared with ypN staging. However, few authors have incorporated the prognostic value of LNR to improve individualized estimates of survival in node-positive breast cancer (BC) patients after neoadjuvant chemotherapy (NACT).
Data from 339 node-positive BC patients after NACT from two independent centers were retrospectively collected. A prognostic model incorporating LNR was built to predict disease-free survival (DFS) based on the Cox proportional hazards model. The discrimination, calibration ability, and clinical utility of the nomogram were evaluated by C-index, calibration curve, risk group stratification, and decision curve analysis (DCA) and were compared with the TNM staging system.
Independent prognostic factors for DFS were age, pathological T stage, LNR, histological grade, ER, Ki67, and lymphovascular invasion, which were all entered into the nomogram. The C-index of the nomogram for predicting DFS was 0.773, which was higher than that of the TNM staging system (C-index: 0.610). The calibration curve indicated close agreement between nomogram predictions and actual observations. Based on the risk group stratification of the nomogram, Kaplan-Meier curves demonstrated significant differences between the low-risk and high-risk patients (p < 0.0001).
The LNR-based nomogram provided more accurate individualized risk prediction of DFS in node-positive BC patients after NACT. This practical tool may assist oncologists in selecting the high-risk patients who are in need of a specific treatment strategy.
Clinical trial identification
Legal entity responsible for the study
Sun Yat-sen Memorial Hospital, Sun Yat-sen University.
Has not received any funding.
All authors have declared no conflicts of interest.