Lymph Node Ratio in Sentinel Lymph Node Biopsy Era: Are We Losing Prognostic Information?

Area of Science:

• Oncology
• Surgical Pathology
• Biostatistics

Background:

• The number of involved axillary lymph nodes (LNs) is a key prognostic factor in early-stage breast cancer (EBC).
• The lymph node ratio (LNR), calculated as the ratio of positive LNs to total examined LNs, is being investigated as a potentially superior prognostic marker.
• This study aimed to evaluate the prognostic value of LNR in EBC using predefined cutoff values.

Purpose of the Study:

• To determine if the lymph node ratio (LNR) is a more effective prognostic indicator than the number of involved lymph nodes in early-stage breast cancer (EBC).
• To assess the association between LNR risk groups and overall survival (OS) in patients with node-positive EBC.
• To investigate the independent prognostic value of LNR when integrated with other clinical and pathological factors.

Main Methods:

• Retrospective analysis of 553 women diagnosed with node-positive EBC between 2001 and 2010.
• Patients were categorized into low (≤0.20), intermediate (0.21-0.65), and high (>0.65) LNR risk groups.
• Proportional hazard modeling and Kaplan-Meier analysis were used to evaluate the association between LNR and overall survival (OS).

Main Results:

• A low LNR (<0.20) was significantly associated with better overall survival (OS) (P < .001).
• LNR demonstrated a correlation with both 5-year and 10-year OS across risk groups.
• Multivariate analysis indicated that LNR, combined with age, ER, PgR, and HER2 status, formed a significant prognostic model (P < .001).

Conclusions:

• The lymph node ratio (LNR) is a significant predictor of overall survival (OS) in early-stage breast cancer (EBC).
• LNR should be considered an independent prognostic variable.
• Incorporating LNR into existing prognostic tools may enhance risk stratification for EBC patients.