Modified lymph node ratio improves the prognostic predictive ability for breast cancer patients compared with other
Ming-Liang Jin1, Yue Gong1, Yu-Cheng Pei2
1Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
Breast (Edinburgh, Scotland)
|November 30, 2019
Summary
A new modified lymph node ratio (mLNR) staging system improves breast cancer prognosis prediction, especially when few lymph nodes are harvested. mLNR outperforms other systems in limited lymph node harvest scenarios.
Area of Science:
- Oncology
- Biostatistics
- Cancer Research
Background:
- Metastatic lymph node (LN) status is a critical prognostic factor in breast cancer.
- Existing lymph node staging systems have limitations, particularly with limited lymph node harvests.
- Novel staging systems are needed to accurately predict patient outcomes.
Purpose of the Study:
- To introduce and evaluate a modified lymph node ratio (mLNR) as a novel breast cancer staging system.
- To compare the prognostic performance of mLNR against established systems like the American Joint Committee on Cancer N stage and the lymph node ratio (LNR).
- To assess the utility of mLNR in scenarios with limited lymph node retrieval.
Main Methods:
- Utilized data from 264,096 breast cancer patients diagnosed between 2004 and 2012 from the Surveillance, Epidemiology, and End Results database.
- Employed restricted cubic spline functions to analyze the relationship between variables and mortality risk.
- Applied Cox proportional hazards models, Akaike's Information Criterion (AIC), and Harrell's concordance index (C-index) to evaluate staging system performance.
Main Results:
- In a cohort with limited lymph node harvest (71.1% of patients), the prognostic accuracy of LNR diminished.
- mLNR demonstrated superior performance in predicting outcomes, particularly in the limited lymph node harvest group.
- Across the entire cohort, mLNR as a continuous variable exhibited the highest predictive ability (AIC: 922021.9, C-index: 0.727).
Conclusions:
- The predictive power of the standard lymph node ratio (LNR) is compromised by limited lymph node retrieval.
- The modified lymph node ratio (mLNR) offers improved prognostic accuracy compared to LNR and other staging systems.
- mLNR emerges as a more robust and powerful lymph node staging system, especially for patients with fewer lymph nodes examined.
