Xiamen City Cancer Center, Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, Xiamen, People's Republic of China.
PLoS One. 2013 Apr 23;8(4):e61410. doi: 10.1371/journal.pone.0061410. Print 2013.
The prevalence of breast cancer varies among countries and regions. This retrospective study investigated the prognostic value of the lymph node ratio (LNR) compared with the number of positive lymph nodes (pN) in Chinese breast cancer patients.
The medical records of female breast cancer patients (N = 2591) were retrospectively evaluated. The association of LNR and TMN staging system were compared with respect to overall, disease-free, and distant metastasis-free survival.
Out of 2591 patients, 2495 underwent modified radical surgery and 96 received breast conserving surgery. All patients had adjuvant chemotherapy following surgery. The median follow up period 66.9 months (range 5-168 months). The 5-year and 10-year overall survival rates were 89.3% and 78.8%, respectively, and 5-year disease-free survival and distant metastasis-free survival rates were 81.6% and 83.5%, respectively. Univariate analysis indicated that in general T, pN, LNR, as well as tumor expression of the estrogen receptor, progesterone receptor, and HER2 were associated with overall, disease-free, and distant metastasis-free survival (all P-values <0.05). Mutlivariate analysis found pN stage and LNR were independent predictors of overall, disease-free, and distant metastasis-free survival (all P-values <0.001). If pN stage and LNR were both included in a multivariate analysis, LNR was still an independent prognostic factor for overall, disease-free, and distant metastasis-free survival (all P-values <0.001).
Our findings support the use of LNR as a predictor of survival in Chinese patients with breast cancer, and that LNR is superior to pN stage in determining disease prognosis.
乳腺癌的患病率在不同国家和地区存在差异。本回顾性研究旨在探讨在中国乳腺癌患者中，与阳性淋巴结数（pN）相比，淋巴结比率（LNR）的预后价值。
回顾性评估了 2591 例女性乳腺癌患者的病历。比较了 LNR 与 TMN 分期系统与总生存、无病生存和无远处转移生存的相关性。
2591 例患者中，2495 例行改良根治术，96 例行保乳手术。所有患者术后均接受辅助化疗。中位随访时间为 66.9 个月（5-168 个月）。5 年和 10 年总生存率分别为 89.3%和 78.8%，5 年无病生存率和无远处转移生存率分别为 81.6%和 83.5%。单因素分析表明，一般来说 T、pN、LNR 以及肿瘤雌激素受体、孕激素受体和 HER2 的表达与总生存、无病生存和无远处转移生存有关（均 P 值<0.05）。多因素分析发现 pN 分期和 LNR 是总生存、无病生存和无远处转移生存的独立预测因素（均 P 值<0.001）。如果 pN 分期和 LNR 均纳入多因素分析，LNR 仍然是总生存、无病生存和无远处转移生存的独立预后因素（均 P 值<0.001）。
本研究结果支持 LNR 作为中国乳腺癌患者生存预测指标的使用，且 LNR 比 pN 分期更能确定疾病预后。
