Age and Axillary Lymph Node Ratio in Postmenopausal Women with T1-T2 Node Positive Breast Cancer
Age and Axillary Lymph Node Ratio in Postmenopausal Women with T1-T2 Node Positive Breast Cancer
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DOI：
10.1634/theoncologist.2010-0044
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发表时间：
2010-10-01
期刊：
影响因子：
5.8
通讯作者：
Nguyen, Nam Phong
中科院分区：
文献类型：
--
作者：
Vinh-Hung, Vincent;Joseph, Sue A.;Nguyen, Nam Phong
目的.本文旨在研究年龄与淋巴结比率（LNR，阳性淋巴结数除以检查淋巴结数）之间的关系，并确定其对乳腺癌（BC）和总体死亡率的影响。从美国国家癌症研究所的监测、流行病学和最终结果（SEER）中选择年龄≥ 50岁、在1988-1997年诊断为单侧组织学证实的T1-T2淋巴结阳性、手术治疗的原发性非转移性BC的妇女。位置、尺度和形状的广义加性模型（GAMLSS）被用来评估年龄与LNR的关系。采用累积发病率函数和基于贝叶斯信息准则（BIC）模型选择的多变量竞争风险分析来研究年龄和LNR对死亡率的影响。低LNR定义为0.65。GAMLSS表现出非线性LNR-年龄关系，从50-70岁的平均LNR 0.26-0.28增加到80岁的0.30和90岁的0.40。50-59岁低LNR女性5年BC死亡风险为9.8% [95%置信区间（CI）8.8%-10.8%]，而>= 80岁低LNR女性的风险为12.6% [95% CI 10.1%-15.0%]，中LNR为18.1% [13.9%-22.1%]，LNR高29.8% [22.7%-36.1%]。5年总死亡风险从低LNR的40.8% [37.5%-43.9%]增加到高LNR的67.4% [61.4%-72.4%]。与年龄在50-59岁之间的低LNR女性相比，年龄≥ 80岁且LNR高的女性的总体死亡风险比为7.49 [6.54-8.59]。高LNR结合年龄较大与BC死亡风险增加3倍和总死亡率风险比增加7倍相关。肿瘤学家2010;15：1050-1062
Purpose. The purpose of this article was to examine the relationship between age and lymph node ratio (LNR, number of positive nodes divided by number of examined nodes), and to determine their effects on breast cancer (BC) and overall mortality.Methods. Women aged >= 50 years, diagnosed in 1988-1997 with a unilateral histologically confirmed T1-T2 node positive surgically treated primary nonmetastatic BC, were selected from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER). Generalized Additive Models for Location Scale and Shape (GAMLSS) were used to evaluate the age-LNR relationship. Cumulative incidence functions and multivariate competing risks analysis based on model selection by the Bayesian Information Criterion (BIC) were used to examine the effect of age and LNR on mortality. Low LNR was defined as 0.65.Results. GAMLSS showed a nonlinear LNR-age relationship, increasing from mean LNR 0.26-0.28 at age 50-70 years to 0.30 at 80 years and 0.40 at 90 years. Compared with a 9.8% [95% confidence interval (CI) 8.8%-10.8%] risk of BC death at 5 years in women aged 50-59 years with low LNR, the risk in women >= 80 years with low LNR was 12.6% [95% CI 10.1%-15.0%], mid-LNR 18.1% [13.9%-22.1%], high LNR 29.8% [22.7%-36.1%]. Five-years overall risk of death increased from 40.8% [37.5%-43.9%] by low LNR to 67.4% [61.4%-72.4%] by high LNR. The overall mortality hazard ratio for age >= 80 years with high LNR was 7.49 [6.54-8.59], as compared with women aged 50-59 years with low LNR.Conclusion. High LNR combined with older age was associated with a threefold increased risk of BC death and a sevenfold increased hazard ratio of overall mortality. The Oncologist 2010;15:1050-1062