Department of Surgery, University of Louisville, Louisville, KY, USA.
J Am Coll Surg. 2011 Jul;213(1):45-52; discussion 52-3. doi: 10.1016/j.jamcollsurg.2011.04.024. Epub 2011 May 20.
The optimal method for classifying lymph node (LN) status in breast cancer patients is unknown. We sought to determine if LN ratio (LNR) improves axillary staging.
Kentucky Cancer Registry data (1996 to 2007) were used to compare LN categorization schemas. Overall survival (OS) was evaluated using the Kaplan-Meier method and log rank tests. Schemas included: LN positive (+) vs negative (-) disease, current American Joint Committee on Cancer (AJCC) staging (0 vs 1 to 3 vs 4 to 9 vs ≥10 LN+), and LNR 0 vs 0.01 to 0.20 vs 0.21 to 0.65 vs >0.65 (LN- vs low, intermediate, and high risk LN+ groups).
There were 1,436 patients who had complete LN evaluation data: 880 (61.3%) were LN- and 556 (39.6%) were LN+; 309 (21.5%) had 1 to 3 positive LNs, 138 (9.6%) had 4 to 9 positive LNs, and 109 (7.6%) had 10 or more positive LNs. For LN+ patients, the median number of positive LNs was 3; median LNR was 0.23. The median follow-up was 65 months. LN status was associated with 5-year OS (91.3% and 73.3% for LN- and LN+ groups, respectively, p < 0.001). Increasing AJCC pN stage was associated with worse OS (5-year OS 80.5%, 75.3%, and 49.8% for pN1 to N3, respectively, p < 0.001). LNR was also associated with OS (5-year OS of 83.1%, 72.7%, and 52.7% for the low, intermediate, and high risk LN+ groups, respectively, p < 0.001). In subgroup analyses of patients in the 1 to 3 and 4 to 9 LN+ groups, OS was statistically associated with LNR (p = 0.021 and p = 0.016, respectively). On multivariable survival analysis, LNR was associated with OS, independent of AJCC categorization, p = 0.003.
LNR was associated with OS, regardless of AJCC LN categories.
目前尚不清楚用于分类乳腺癌患者淋巴结（LN）状态的最佳方法。我们旨在确定 LN 比值（LNR）是否能改善腋窝分期。
利用肯塔基州癌症登记处的数据（1996 年至 2007 年）比较 LN 分类方案。采用 Kaplan-Meier 法和对数秩检验评估总生存（OS）。方案包括：LN 阳性（+）与阴性（-）疾病，当前美国癌症联合委员会（AJCC）分期（0 与 1 至 3 与 4 至 9 与 ≥10 LN+）和 LNR 0 与 0.01 至 0.20 至 0.21 至 0.65 至 >0.65（LN-与低、中、高危 LN+组）。
共有 1436 例患者有完整的 LN 评估数据：880 例（61.3%）为 LN-，556 例（39.6%）为 LN+；309 例（21.5%）有 1 至 3 个阳性 LNs，138 例（9.6%）有 4 至 9 个阳性 LNs，109 例（7.6%）有 10 个或更多阳性 LNs。对于 LN+患者，阳性 LNs 的中位数为 3 个；中位数 LNR 为 0.23。中位随访时间为 65 个月。LN 状态与 5 年 OS 相关（LN-和 LN+组分别为 91.3%和 73.3%，p<0.001）。AJCC pN 分期升高与 OS 较差相关（pN1 至 N3 期分别为 5 年 OS 80.5%、75.3%和 49.8%，p<0.001）。LNR 也与 OS 相关（低、中、高危 LN+组的 5 年 OS 分别为 83.1%、72.7%和 52.7%，p<0.001）。在 1 至 3 个和 4 至 9 个 LN+组患者的亚组分析中，OS 与 LNR 统计学相关（p=0.021 和 p=0.016）。多变量生存分析显示，LNR 与 OS 相关，独立于 AJCC 分类，p=0.003。
LNR 与 OS 相关，与 AJCC LN 分类无关。
