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Lymph node ratio as an independent prognostic factor for breast cancer-related mortality in patients with node-positive breast cancer


1 Department of Radiation Oncology, Faculty of Medicine, Marmara University, Istanbul, Turkey
2 Anadolu Medical Center, Gebze, Kocaeli, Turkey
3 Department of Radiation Oncology, Acibadem University, Istanbul, Turkey

Correspondence Address:
Ilknur Alsan Cetin,
Department of Radiation Oncology, Faculty of Medicine, Marmara University, Fevzi Cakmak Mah., Muhsin Yazicioglu Cd. No: 10, 34899 Pendik, Istanbul
Turkey
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jcrt.JCRT_1034_19

Aim: This study assessed whether prognostic information could be obtained in patients with lymph node (LN)-positive breast cancer based on their LN ratios (LNRs) and explored the relationships between other potential prognostic factors and survival. Setting and Design: This was a retrospective clinical study. Materials and Methods: This study included 608 women with node-positive nonmetastatic breast cancer. Clinical and pathologic data were retrospectively evaluated. The median age was 51 years (range: 23–84 years). All patients received adjuvant radiotherapy after radical surgery. A total dose of 50 Gy was administered to the chest wall or breast and LN regions with 2 Gy daily fractions. A 10-Gy boost was administered to the breast tumor bed. The cutoff value of LNR was defined as low risk (<0.21) in 278 patients, intermediate risk (0.21–0.65) in 217 patients, and high risk (>0.65) in 113 patients. Prognostic variables included patient characteristics, disease characteristics, and interventional factors. The primary endpoint was overall survival and the secondary endpoint was breast cancer-related mortality. Statistical Analysis Used: Statistical analyses were performed using the Kaplan–Meier method, log-rank test, and Cox regression analysis. P value was required to be <0.05. Results: Within a median follow-up period of 95.4 months (range: 5–232.4 months), overall survival rates for 10 and 15 years were 66% and 53%, respectively. Multivariate analysis revealed that LNR (P = 0.026), estrogen receptor status (ERS) (P = 0.021), age (P = 0.04), and smoking (P = 0.024) were independent significant prognostic factors for overall survival. Breast cancer-related mortality rates at 10 and 15 years were 70.7% and 60%, respectively. LNR (P = 0.03) and ERS (P = 0.002) were independent significant prognostic factors for breast cancer-related mortality. Conclusions: LNR and ERS were significant prognostic factors for survival at all endpoints.


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    -  Cetin IA
    -  Akay SU
    -  Caglar Ozkok HB
    -  Sengoz M
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