Lymph node ratio is more valuable than level III involvement for prediction of outcome in node-positive breast carcinoma patients
Lymph node ratio is more valuable than level III involvement for prediction of outcome in node-positive breast carcinoma patients
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DOI：
10.1007/s00268-006-0487-5
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发表时间：
2007-02-01
影响因子：
2.6
通讯作者：
Berberoglu, Ugur
中科院分区：
文献类型：
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作者：
Yildirim, Emin;Berberoglu, Ugur
背景：我们研究了腋窝淋巴结阳性（PN）的不同表达与淋巴结阳性乳腺癌患者预后之间的关系，以确定这些表达中的最佳预测因子，并评估解剖性高水平累及是否是一个独立的预后因素。研究设计：在这项回顾性研究中，主要终点是远处复发（DR）、局部区域复发（LRR）和无病生存（DFS）。采用生存和回归方法对704例PN患者的资料进行单因素和多因素预后分析。结果：在多因素分析中，除年龄、肿瘤大小和淋巴血管侵袭（LVI）外，PN的数量、PN的比率、PN的对数几率和III级（L-III）受累分别是DR的显著因素。在包括所有淋巴结累及表达的最终模型中，年龄（连续P = 0.001；风险比[HR]: 0.98； 95%置信区间[95% CI]: 0.96-0.99）、肿瘤大小（连续P < 0.0001；风险比[HR]: 1.3; 95% CI: 1.2-1.5）、LVI（是vs不是：P = 0.005；风险比：1.6;95% CI, 1.2-2.2）和PN比（连续P = 0.02；风险比：1.03;95% CI, 1.01-1.06）是dr的独立预后因素。LRR， PN比(连续P = 0.001；风险比：1.02；95% CI, 1.01-1.03)是除年龄（连续：P = 0.02; HR: 0.98; 95% CI, 0.97-0.99）和肿瘤大小（连续：P = 0.04; HR: 1.3; 95% CI, 1.1-1.6）外最重要的因素。当患者按PN数量分类分层时（1-3 vs. 4-9 vs. >= N >= 10），有和没有L-III受累的患者的DFSs之间没有差异。相比之下，当患者按L-III受累程度分层时，按数量分类的DFSs有统计学差异。结论：在预测淋巴结阳性乳腺癌患者预后时，PN的比值比PN的数目更有价值。III级受累不是局部或远处复发的独立预后指标。
Background: We examined the relationship between different expressions of positive axillary lymph nodes (PN) and the outcomes of node-positive breast carcinoma patients to determine the best predictor(s) among these expressions and to assess whether anatomic high level involvement is an independent prognostic factor.Study Design: In this retrospective study, the primary endpoints were distant recurrence (DR), locoregional recurrences (LRR), and disease-free survival (DFS). Univariate and multivariate prognostic factor analyses were carried out using survival and regression methods in the data of 704 patients with PN.Results: In multivariate analysis, the number of PN, ratio of PN, log odds of PN, and level III (L-III) involvement, separately, were significant factors for DR in addition to age, tumor size, and lymphovascular invasion (LVI). In the final model including all expressions of nodal involvement, age (continuous P = 0.001; hazard ratio [HR]: 0.98; 95% confidence Interval [95% CI]: 0.96-0.99), tumor size (continuous: P < 0.0001; HR: 1.3; 95% CI, 1.2-1.5), LVI (yes vs. no: P = 0.005; HR: 1.6; 95% CI, 1.2-2.2), and ratio of PN (continuous: P = 0.02; HR: 1.03; 95% CI, 1.01-1.06) were the independent prognostic factors for DR. For LRR, ratio of PN (continuous: P = 0.001; HR: 1.02; 95% CI, 1.01-1.03) was the most important factor in addition to age (continuous: P = 0.02; HR: 0.98; 95% CI, 0.97-0.99) and tumor size (continuous: P = 0.04; HR: 1.3; 95% CI, 1.1-1.6). When patients were stratified by number categories of PN (1-3 vs. 4-9 vs. >= N >= 10), there was no difference between DFSs of patients with and without L-III involvement. In contrast, when patients were stratified by L-III involvement, DFSs according to the number categories were statistically different.Conclusions: Ratio of PN was more valuable than number of PN for predicting outcome in node-positive breast carcinoma patients. Level III involvement was not an independent prognostic indicator either for locoregional or for distant recurrences.