Exploring the most appropriate lymph node staging system for node-positive breast cancer patients and constructing...

Area of Science:

• Oncology
• Biostatistics
• Cancer Prognostics

Background:

• Lymph node (LN) status is a critical prognostic indicator for breast cancer (BC) patients.
• Accurate LN staging is essential for predicting patient outcomes and guiding treatment strategies.
• Existing staging systems may have varying predictive power depending on patient characteristics.

Purpose of the Study:

• To compare the predictive performance of three lymph node staging systems: pN stage, lymph node ratio (LNR), and log odds of positive lymph nodes (LODDS).
• To develop and validate nomogram models for predicting overall survival (OS) in node-positive breast cancer patients.
• To determine if the optimal staging system varies based on the number of removed lymph nodes (RLNs).

Main Methods:

• Analysis of a large cohort (71,213 patients) from the SEER database, with external validation using 667 hospital cases.
• Patients were stratified into two groups based on the number of removed lymph nodes (RLNs < 10 and RLNs ≥ 10).
• Prognostic abilities were assessed using C-indexes and AUC values; LASSO regression identified significant prognostic factors for nomogram development.

Main Results:

• LNR demonstrated superior predictive performance over pN and LODDS when RLNs < 10.
• pN stage showed better predictive ability when RLNs ≥ 10.
• Developed nomogram models exhibited excellent clinical applicability, accuracy, and discrimination in both training and validation cohorts.

Conclusions:

• The choice of lymph node staging system in breast cancer should be guided by the number of removed lymph nodes.
• Novel nomograms integrating key prognostic factors show high performance for predicting overall survival.
• These validated nomograms can assist clinicians in patient counseling and optimizing treatment decisions.