Association between Lymph Node Ratio and Disease Specific Survival in Breast Cancer Patients with One or Two Positive Lymph Nodes Stratified by Different Local Treatment Modalities
Identifieur interne : 001490 ( Pmc/Checkpoint ); précédent : 001489; suivant : 001491Association between Lymph Node Ratio and Disease Specific Survival in Breast Cancer Patients with One or Two Positive Lymph Nodes Stratified by Different Local Treatment Modalities
Auteurs : Ruoxi Hong [République populaire de Chine] ; Zhen Dai [République populaire de Chine] ; Wenjie Zhu [République populaire de Chine] ; Binghe Xu [République populaire de Chine]Source :
- PLoS ONE [ 1932-6203 ] ; 2015.
Abstract
Results of the American College of Surgeons Oncology Group (ACOSOG) Z0011 trial indicated that complete axillary node dissection (ALND) may not be warranted in some breast cancer patients with low tumor burden who are undergoing breast-conserving surgery following whole-breast irradiation. However, this study did not address patients undergoing mastectomy or those undergoing breast-conserving surgery without whole-breast radiotherapy. Given that lymph node ratio (LNR; ratio of positive lymph nodes to the total number removed) has been shown to be a prognostic factor in breast cancer, we first sought to determine the prognostic value of LNR in a low risk population comparable to that of the Z0011 trial and further to investigate whether the prognostic significance differs with local treatment modality.
We used the Surveillance Epidemiology and End Results (SEER) database to identify breast cancer patients with T1-T2 tumor and 1–2 positive nodes. Patients were subclassified by the local therapy they underwent for the primary tumor. The prognostic value of LNR in predicting disease-specific survival (DSS) was examined in each treatment group.
A total of 53,109 patients were included. In the subgroup of 20,602 patients who underwent lumpectomy following radiotherapy, LNR was not found to be significantly associated with DSS in both the univariate and multivariate model. For the 4,664 patients treated with mastectomy following radiotherapy, 6,811 treated with lumpectomy without radiotherapy and 21,031 with mastectomy without radiotherapy, LNR independently predict DSS in each of these subgroups.
Our results
Url:
DOI: 10.1371/journal.pone.0138908
PubMed: 26513258
PubMed Central: 4626029
Affiliations:
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PMC:4626029Le document en format XML
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<author><name sortKey="Hong, Ruoxi" sort="Hong, Ruoxi" uniqKey="Hong R" first="Ruoxi" last="Hong">Ruoxi Hong</name>
<affiliation wicri:level="3"><nlm:aff id="aff001"><addr-line>Department of Medical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China</addr-line>
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<country xml:lang="fr">République populaire de Chine</country>
<wicri:regionArea>Department of Medical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing</wicri:regionArea>
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<author><name sortKey="Dai, Zhen" sort="Dai, Zhen" uniqKey="Dai Z" first="Zhen" last="Dai">Zhen Dai</name>
<affiliation wicri:level="1"><nlm:aff id="aff002"><addr-line>Chengdu Center for Disease Control and Prevention, Chengdu, China</addr-line>
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<country xml:lang="fr">République populaire de Chine</country>
<wicri:regionArea>Chengdu Center for Disease Control and Prevention, Chengdu</wicri:regionArea>
<wicri:noRegion>Chengdu</wicri:noRegion>
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<author><name sortKey="Zhu, Wenjie" sort="Zhu, Wenjie" uniqKey="Zhu W" first="Wenjie" last="Zhu">Wenjie Zhu</name>
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<country xml:lang="fr">République populaire de Chine</country>
<wicri:regionArea>Department of Medical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing</wicri:regionArea>
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<author><name sortKey="Xu, Binghe" sort="Xu, Binghe" uniqKey="Xu B" first="Binghe" last="Xu">Binghe Xu</name>
<affiliation wicri:level="3"><nlm:aff id="aff001"><addr-line>Department of Medical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China</addr-line>
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<country xml:lang="fr">République populaire de Chine</country>
<wicri:regionArea>Department of Medical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing</wicri:regionArea>
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<series><title level="j">PLoS ONE</title>
<idno type="eISSN">1932-6203</idno>
<imprint><date when="2015">2015</date>
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<front><div type="abstract" xml:lang="en"><sec id="sec001"><title>Purpose</title>
<p>Results of the American College of Surgeons Oncology Group (ACOSOG) Z0011 trial indicated that complete axillary node dissection (ALND) may not be warranted in some breast cancer patients with low tumor burden who are undergoing breast-conserving surgery following whole-breast irradiation. However, this study did not address patients undergoing mastectomy or those undergoing breast-conserving surgery without whole-breast radiotherapy. Given that lymph node ratio (LNR; ratio of positive lymph nodes to the total number removed) has been shown to be a prognostic factor in breast cancer, we first sought to determine the prognostic value of LNR in a low risk population comparable to that of the Z0011 trial and further to investigate whether the prognostic significance differs with local treatment modality.</p>
</sec>
<sec id="sec002"><title>Method</title>
<p>We used the Surveillance Epidemiology and End Results (SEER) database to identify breast cancer patients with T1-T2 tumor and 1–2 positive nodes. Patients were subclassified by the local therapy they underwent for the primary tumor. The prognostic value of LNR in predicting disease-specific survival (DSS) was examined in each treatment group.</p>
</sec>
<sec id="sec003"><title>Results</title>
<p>A total of 53,109 patients were included. In the subgroup of 20,602 patients who underwent lumpectomy following radiotherapy, LNR was not found to be significantly associated with DSS in both the univariate and multivariate model. For the 4,664 patients treated with mastectomy following radiotherapy, 6,811 treated with lumpectomy without radiotherapy and 21,031 with mastectomy without radiotherapy, LNR independently predict DSS in each of these subgroups.</p>
</sec>
<sec id="sec004"><title>Conclusions</title>
<p>Our results <italic>add evidence to the concept</italic>
that axillary dissection could be omitted in patients with one or two positive nodes following breast-conserving surgery and whole breast radiation.</p>
</sec>
</div>
</front>
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<pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">PLoS One</journal-id>
<journal-id journal-id-type="iso-abbrev">PLoS ONE</journal-id>
<journal-id journal-id-type="publisher-id">plos</journal-id>
<journal-id journal-id-type="pmc">plosone</journal-id>
<journal-title-group><journal-title>PLoS ONE</journal-title>
</journal-title-group>
<issn pub-type="epub">1932-6203</issn>
<publisher><publisher-name>Public Library of Science</publisher-name>
<publisher-loc>San Francisco, CA USA</publisher-loc>
</publisher>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">26513258</article-id>
<article-id pub-id-type="pmc">4626029</article-id>
<article-id pub-id-type="doi">10.1371/journal.pone.0138908</article-id>
<article-id pub-id-type="publisher-id">PONE-D-15-11467</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject>
</subj-group>
</article-categories>
<title-group><article-title>Association between Lymph Node Ratio and Disease Specific Survival in Breast Cancer Patients with One or Two Positive Lymph Nodes Stratified by Different Local Treatment Modalities</article-title>
<alt-title alt-title-type="running-head">LNR and DSS in Low-Risk Breast Cancer Patients</alt-title>
</title-group>
<contrib-group><contrib contrib-type="author" equal-contrib="yes"><name><surname>Hong</surname>
<given-names>Ruoxi</given-names>
</name>
<xref ref-type="aff" rid="aff001"><sup>1</sup>
</xref>
</contrib>
<contrib contrib-type="author" equal-contrib="yes"><name><surname>Dai</surname>
<given-names>Zhen</given-names>
</name>
<xref ref-type="aff" rid="aff002"><sup>2</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Zhu</surname>
<given-names>Wenjie</given-names>
</name>
<xref ref-type="aff" rid="aff001"><sup>1</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Xu</surname>
<given-names>Binghe</given-names>
</name>
<xref ref-type="aff" rid="aff001"><sup>1</sup>
</xref>
<xref rid="cor001" ref-type="corresp">*</xref>
</contrib>
</contrib-group>
<aff id="aff001"><label>1</label>
<addr-line>Department of Medical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China</addr-line>
</aff>
<aff id="aff002"><label>2</label>
<addr-line>Chengdu Center for Disease Control and Prevention, Chengdu, China</addr-line>
</aff>
<contrib-group><contrib contrib-type="editor"><name><surname>Chu</surname>
<given-names>Pei-Yi</given-names>
</name>
<role>Editor</role>
<xref ref-type="aff" rid="edit1"></xref>
</contrib>
</contrib-group>
<aff id="edit1"><addr-line>School of Medicine, Fu Jen Catholic University, TAIWAN</addr-line>
</aff>
<author-notes><fn fn-type="conflict" id="coi001"><p><bold>Competing Interests: </bold>
The authors have declared that no competing interests exist.</p>
</fn>
<fn fn-type="con" id="contrib001"><p>Conceived and designed the experiments: BX RH. Performed the experiments: RH WZ BX. Analyzed the data: ZD. Contributed reagents/materials/analysis tools: ZD. Wrote the paper: RH ZD WZ BX.</p>
</fn>
<corresp id="cor001">* E-mail: <email>xubinghe@medmail.com.cn</email>
</corresp>
</author-notes>
<pub-date pub-type="epub"><day>29</day>
<month>10</month>
<year>2015</year>
</pub-date>
<pub-date pub-type="collection"><year>2015</year>
</pub-date>
<volume>10</volume>
<issue>10</issue>
<elocation-id>e0138908</elocation-id>
<history><date date-type="received"><day>18</day>
<month>3</month>
<year>2015</year>
</date>
<date date-type="accepted"><day>6</day>
<month>9</month>
<year>2015</year>
</date>
</history>
<permissions><copyright-year>2015</copyright-year>
<copyright-holder>Hong et al</copyright-holder>
<license xlink:href="http://creativecommons.org/licenses/by/4.0/"><license-p>This is an open access article distributed under the terms of the <ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">Creative Commons Attribution License</ext-link>
, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited</license-p>
</license>
</permissions>
<self-uri content-type="pdf" xlink:type="simple" xlink:href="pone.0138908.pdf"></self-uri>
<abstract><sec id="sec001"><title>Purpose</title>
<p>Results of the American College of Surgeons Oncology Group (ACOSOG) Z0011 trial indicated that complete axillary node dissection (ALND) may not be warranted in some breast cancer patients with low tumor burden who are undergoing breast-conserving surgery following whole-breast irradiation. However, this study did not address patients undergoing mastectomy or those undergoing breast-conserving surgery without whole-breast radiotherapy. Given that lymph node ratio (LNR; ratio of positive lymph nodes to the total number removed) has been shown to be a prognostic factor in breast cancer, we first sought to determine the prognostic value of LNR in a low risk population comparable to that of the Z0011 trial and further to investigate whether the prognostic significance differs with local treatment modality.</p>
</sec>
<sec id="sec002"><title>Method</title>
<p>We used the Surveillance Epidemiology and End Results (SEER) database to identify breast cancer patients with T1-T2 tumor and 1–2 positive nodes. Patients were subclassified by the local therapy they underwent for the primary tumor. The prognostic value of LNR in predicting disease-specific survival (DSS) was examined in each treatment group.</p>
</sec>
<sec id="sec003"><title>Results</title>
<p>A total of 53,109 patients were included. In the subgroup of 20,602 patients who underwent lumpectomy following radiotherapy, LNR was not found to be significantly associated with DSS in both the univariate and multivariate model. For the 4,664 patients treated with mastectomy following radiotherapy, 6,811 treated with lumpectomy without radiotherapy and 21,031 with mastectomy without radiotherapy, LNR independently predict DSS in each of these subgroups.</p>
</sec>
<sec id="sec004"><title>Conclusions</title>
<p>Our results <italic>add evidence to the concept</italic>
that axillary dissection could be omitted in patients with one or two positive nodes following breast-conserving surgery and whole breast radiation.</p>
</sec>
</abstract>
<funding-group><funding-statement>The authors have no support or funding to report.</funding-statement>
</funding-group>
<counts><fig-count count="1"></fig-count>
<table-count count="3"></table-count>
<page-count count="9"></page-count>
</counts>
<custom-meta-group><custom-meta id="data-availability"><meta-name>Data Availability</meta-name>
<meta-value>Data contain patient identifying information and are unsuitable for public deposition. Data may be requested from the corresponding author.</meta-value>
</custom-meta>
</custom-meta-group>
</article-meta>
<notes><title>Data Availability</title>
<p>Data contain patient identifying information and are unsuitable for public deposition. Data may be requested from the corresponding author.</p>
</notes>
</front>
</pmc>
<affiliations><list><country><li>République populaire de Chine</li>
</country>
<settlement><li>Pékin</li>
</settlement>
</list>
<tree><country name="République populaire de Chine"><noRegion><name sortKey="Hong, Ruoxi" sort="Hong, Ruoxi" uniqKey="Hong R" first="Ruoxi" last="Hong">Ruoxi Hong</name>
</noRegion>
<name sortKey="Dai, Zhen" sort="Dai, Zhen" uniqKey="Dai Z" first="Zhen" last="Dai">Zhen Dai</name>
<name sortKey="Xu, Binghe" sort="Xu, Binghe" uniqKey="Xu B" first="Binghe" last="Xu">Binghe Xu</name>
<name sortKey="Zhu, Wenjie" sort="Zhu, Wenjie" uniqKey="Zhu W" first="Wenjie" last="Zhu">Wenjie Zhu</name>
</country>
</tree>
</affiliations>
</record>
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