Does the axillary lymph node ratio have any added prognostic value over pN staging for South East Asian breast cancer patients?
INTRODUCTION: Lymph node ratio (LNR, i.e. the ratio of the number of positive nodes to the total number of nodes excised) is reported to be superior to the absolute number of nodes involved (pN stage) in classifying patients at high versus low risk of death following breast cancer. The added prognos...
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doaj-bd03ba36b416451ba520293f7e1cce2b2020-11-24T21:26:05ZengPublic Library of Science (PLoS)PLoS ONE1932-62032012-01-0179e4580910.1371/journal.pone.0045809Does the axillary lymph node ratio have any added prognostic value over pN staging for South East Asian breast cancer patients?Nakul SaxenaMikael HartmanCheng-Har YipNirmala Bhoo-PathyLay Wai KhinNur Aishah TaibLai-Meng LooiSiew-Eng LimSoo-Chin LeeHelena M VerkooijenINTRODUCTION: Lymph node ratio (LNR, i.e. the ratio of the number of positive nodes to the total number of nodes excised) is reported to be superior to the absolute number of nodes involved (pN stage) in classifying patients at high versus low risk of death following breast cancer. The added prognostic value of LNR over pN in addition to other prognostic factors has never been assessed. METHODS: All patients diagnosed with lymph node positive, non-metastatic invasive breast cancer at the National University Hospital (Singapore) and University of Malaya Medical Center (Kuala Lumpur) between 1990-2007 were included (n = 1589). Overall survival of the patients was estimated by the Kaplan Meier method for LNR [categorized as low (>0 and <0.2), intermediate (0.2-0.65) and high (>0.65-1)] and pN staging [pN1, pN2 and pN3]. Adjusted overall relative mortality risks associated with LNR and pN were calculated by Cox regression. The added prognostic value of LNR over pN was evaluated by comparing the discriminating capacity (as indicated by the c statistic) of two multivariate models, one including pN and one including LNR. RESULTS: LNR was superior to pN in categorizing mortality risks for women ≥60 years, those with ER negative or grade 3 tumors. In combination with other factors (i.e. age, treatment, grade, tumor size and receptor status), substituting pN by LNR did not result in better discrimination of women at high versus low risk of death, neither for the entire cohort (c statistic 0.72 [0.70-0.75] and 0.73 [0.71-0.76] respectively for pN versus LNR), nor for the subgroups mentioned above. CONCLUSION: In combination with other prognosticators, substitution of pN by LNR did not provide any added prognostic value for South East Asian breast cancer patients.http://europepmc.org/articles/PMC3454359?pdf=render |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Nakul Saxena Mikael Hartman Cheng-Har Yip Nirmala Bhoo-Pathy Lay Wai Khin Nur Aishah Taib Lai-Meng Looi Siew-Eng Lim Soo-Chin Lee Helena M Verkooijen |
spellingShingle |
Nakul Saxena Mikael Hartman Cheng-Har Yip Nirmala Bhoo-Pathy Lay Wai Khin Nur Aishah Taib Lai-Meng Looi Siew-Eng Lim Soo-Chin Lee Helena M Verkooijen Does the axillary lymph node ratio have any added prognostic value over pN staging for South East Asian breast cancer patients? PLoS ONE |
author_facet |
Nakul Saxena Mikael Hartman Cheng-Har Yip Nirmala Bhoo-Pathy Lay Wai Khin Nur Aishah Taib Lai-Meng Looi Siew-Eng Lim Soo-Chin Lee Helena M Verkooijen |
author_sort |
Nakul Saxena |
title |
Does the axillary lymph node ratio have any added prognostic value over pN staging for South East Asian breast cancer patients? |
title_short |
Does the axillary lymph node ratio have any added prognostic value over pN staging for South East Asian breast cancer patients? |
title_full |
Does the axillary lymph node ratio have any added prognostic value over pN staging for South East Asian breast cancer patients? |
title_fullStr |
Does the axillary lymph node ratio have any added prognostic value over pN staging for South East Asian breast cancer patients? |
title_full_unstemmed |
Does the axillary lymph node ratio have any added prognostic value over pN staging for South East Asian breast cancer patients? |
title_sort |
does the axillary lymph node ratio have any added prognostic value over pn staging for south east asian breast cancer patients? |
publisher |
Public Library of Science (PLoS) |
series |
PLoS ONE |
issn |
1932-6203 |
publishDate |
2012-01-01 |
description |
INTRODUCTION: Lymph node ratio (LNR, i.e. the ratio of the number of positive nodes to the total number of nodes excised) is reported to be superior to the absolute number of nodes involved (pN stage) in classifying patients at high versus low risk of death following breast cancer. The added prognostic value of LNR over pN in addition to other prognostic factors has never been assessed. METHODS: All patients diagnosed with lymph node positive, non-metastatic invasive breast cancer at the National University Hospital (Singapore) and University of Malaya Medical Center (Kuala Lumpur) between 1990-2007 were included (n = 1589). Overall survival of the patients was estimated by the Kaplan Meier method for LNR [categorized as low (>0 and <0.2), intermediate (0.2-0.65) and high (>0.65-1)] and pN staging [pN1, pN2 and pN3]. Adjusted overall relative mortality risks associated with LNR and pN were calculated by Cox regression. The added prognostic value of LNR over pN was evaluated by comparing the discriminating capacity (as indicated by the c statistic) of two multivariate models, one including pN and one including LNR. RESULTS: LNR was superior to pN in categorizing mortality risks for women ≥60 years, those with ER negative or grade 3 tumors. In combination with other factors (i.e. age, treatment, grade, tumor size and receptor status), substituting pN by LNR did not result in better discrimination of women at high versus low risk of death, neither for the entire cohort (c statistic 0.72 [0.70-0.75] and 0.73 [0.71-0.76] respectively for pN versus LNR), nor for the subgroups mentioned above. CONCLUSION: In combination with other prognosticators, substitution of pN by LNR did not provide any added prognostic value for South East Asian breast cancer patients. |
url |
http://europepmc.org/articles/PMC3454359?pdf=render |
work_keys_str_mv |
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