Modified lymph node ratio improves the prognostic predictive ability for breast cancer patients compared with other lymph node staging systems
Background: Metastatic regional lymph nodes (LN) is a strong predictor of worse long-term outcome. Therefore, different LN staging systems have been proposed in recent years. In this study, we proposed a modified lymph node ratio (mLNR) as a new lymph node staging system and then compared the progno...
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doaj-732d91d497674ab8aaaeb0b21fb221ba2020-11-25T04:08:20ZengElsevierBreast1532-30802020-02-014993100Modified lymph node ratio improves the prognostic predictive ability for breast cancer patients compared with other lymph node staging systemsMing-Liang Jin0Yue Gong1Yu-Cheng Pei2Peng Ji3Xin Hu4Zhi-Ming Shao5Department 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, ChinaDepartment 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, ChinaPrecision Cancer Medicine Center, Shanghai, 200032, ChinaDepartment 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, ChinaDepartment of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, 200032, China; Corresponding author. Key Laboratory of Breast Cancer in Shanghai, Department of Breast Surgery, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai 200032, PR China.Department 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; Institutes of Biomedical Science, Fudan University, Shanghai, 200032, China; Corresponding author. Department of Breast Surgery Fudan University Shanghai Cancer Center 270 Dong-An Road, Shanghai, 200032, PR China.Background: Metastatic regional lymph nodes (LN) is a strong predictor of worse long-term outcome. Therefore, different LN staging systems have been proposed in recent years. In this study, we proposed a modified lymph node ratio (mLNR) as a new lymph node staging system and then compared the prognostic performance of mLNR with American Joint Committee on Cancer N stage, lymph node ratio (LNR) and log odds of metastatic lymph nodes in breast cancer patients. Methods: Breast cancer patients who underwent surgery between 2004 and 2012 were identified from the Surveillance, Epidemiology, and End Results database. Restricted cubic spline functions were calculated to characterize the association between variables and the risk of death. The Cox proportional hazards models were constructed to assess the predictive ability of different lymph node staging systems using the Akaike’s Information Criterion (AIC) and Harrell’s concordance index (C-index). Results: A total of 264,096 breast cancer patients were enrolled and 187,785 (71.1%) patients had a limited number of LNs harvested. In the limited LN harvest cohort, the prognostic performance of LNR decreased and mLNR could greatly solve this problem. In addition, among the entire cohort, mLNR modeled as a continuous value had the best predictive ability (AIC: 922021.9 and C-index: 0.727) than other lymph node staging systems. Conclusions: The predictive ability of LNR is restricted by a limited LN harvest. However, mLNR shows superiority to LNR and other lymph node staging systems especially in a limited LN harvest cohort, making mLNR the most powerful lymph node staging systems.http://www.sciencedirect.com/science/article/pii/S0960977619305958Breast cancerLymph node stagingPrognosisLymph node ratioLog odds of positive lymph nodes |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Ming-Liang Jin Yue Gong Yu-Cheng Pei Peng Ji Xin Hu Zhi-Ming Shao |
spellingShingle |
Ming-Liang Jin Yue Gong Yu-Cheng Pei Peng Ji Xin Hu Zhi-Ming Shao Modified lymph node ratio improves the prognostic predictive ability for breast cancer patients compared with other lymph node staging systems Breast Breast cancer Lymph node staging Prognosis Lymph node ratio Log odds of positive lymph nodes |
author_facet |
Ming-Liang Jin Yue Gong Yu-Cheng Pei Peng Ji Xin Hu Zhi-Ming Shao |
author_sort |
Ming-Liang Jin |
title |
Modified lymph node ratio improves the prognostic predictive ability for breast cancer patients compared with other lymph node staging systems |
title_short |
Modified lymph node ratio improves the prognostic predictive ability for breast cancer patients compared with other lymph node staging systems |
title_full |
Modified lymph node ratio improves the prognostic predictive ability for breast cancer patients compared with other lymph node staging systems |
title_fullStr |
Modified lymph node ratio improves the prognostic predictive ability for breast cancer patients compared with other lymph node staging systems |
title_full_unstemmed |
Modified lymph node ratio improves the prognostic predictive ability for breast cancer patients compared with other lymph node staging systems |
title_sort |
modified lymph node ratio improves the prognostic predictive ability for breast cancer patients compared with other lymph node staging systems |
publisher |
Elsevier |
series |
Breast |
issn |
1532-3080 |
publishDate |
2020-02-01 |
description |
Background: Metastatic regional lymph nodes (LN) is a strong predictor of worse long-term outcome. Therefore, different LN staging systems have been proposed in recent years. In this study, we proposed a modified lymph node ratio (mLNR) as a new lymph node staging system and then compared the prognostic performance of mLNR with American Joint Committee on Cancer N stage, lymph node ratio (LNR) and log odds of metastatic lymph nodes in breast cancer patients. Methods: Breast cancer patients who underwent surgery between 2004 and 2012 were identified from the Surveillance, Epidemiology, and End Results database. Restricted cubic spline functions were calculated to characterize the association between variables and the risk of death. The Cox proportional hazards models were constructed to assess the predictive ability of different lymph node staging systems using the Akaike’s Information Criterion (AIC) and Harrell’s concordance index (C-index). Results: A total of 264,096 breast cancer patients were enrolled and 187,785 (71.1%) patients had a limited number of LNs harvested. In the limited LN harvest cohort, the prognostic performance of LNR decreased and mLNR could greatly solve this problem. In addition, among the entire cohort, mLNR modeled as a continuous value had the best predictive ability (AIC: 922021.9 and C-index: 0.727) than other lymph node staging systems. Conclusions: The predictive ability of LNR is restricted by a limited LN harvest. However, mLNR shows superiority to LNR and other lymph node staging systems especially in a limited LN harvest cohort, making mLNR the most powerful lymph node staging systems. |
topic |
Breast cancer Lymph node staging Prognosis Lymph node ratio Log odds of positive lymph nodes |
url |
http://www.sciencedirect.com/science/article/pii/S0960977619305958 |
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