Wang Zhe, Chong Wei, Zhang Huikun, Liu Xiaoli, Zhao Yawen, Guo Zhifang, Fu Li, Ma Yongjie, Gu Feng
Department of Tumor Cell Biology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China.
Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.
Front Cell Dev Biol. 2022 Apr 4;10:784920. doi: 10.3389/fcell.2022.784920. eCollection 2022.
Increasing studies have demonstrated lymph node ratio (LNR) to be an accurate prognostic indicator in breast cancer and an alternative to pN staging; however, the AJCC-TNM staging system classified apical or infraclavicular/ipsilateral supraclavicular lymph node-positive (APN(+)) patients with a worse prognosis as the pN3 stage. Until now, different reports on LNR in breast cancer have ignored this possibility. Consequently, it is necessary to discuss the role of APN(+) patients in the LNR system to obtain a precise LNR that predicts the prognosis accurately. We collected data on 10,120 breast cancer patients, including 3,936 lymph node-positive patients (3,283 APN(-) and 653 APN(+) patients), who visited our hospital from 2007 to 2012. Then we applied X-tile analysis to calculate cut-off values and conduct survival analysis and multivariate analysis to evaluate patients' prognosis. We confirmed that some APN(+) patients were mis-subgrouped according to previously reported LNR, indicating that APN(+) patients should be excluded in the application of LNR to predict prognosis. Then we applied X-tile analysis to calculate two cut-off values (0.15 and 0.34) for LNR-APN(-) patients and conducted survival analysis and found that LNR-APN(-) staging was superior to pN staging in predicting the prognosis of APN(-) breast cancer patients. From this study, we conclude that excluding APN(+) patients is the most necessary condition for effective implementation of the LNR system. LNR-APN(-) staging could be a more comprehensive approach in predicting prognosis and guiding clinicians to provide accurate and appropriate treatment.
越来越多的研究表明，淋巴结比率（LNR）是乳腺癌准确的预后指标，也是pN分期的替代指标；然而，美国癌症联合委员会（AJCC）的TNM分期系统将预后较差的腋窝或锁骨下/同侧锁骨上淋巴结阳性（APN(+)）患者归类为pN3期。到目前为止，关于乳腺癌LNR的不同报道都忽略了这种可能性。因此，有必要讨论APN(+)患者在LNR系统中的作用，以获得能准确预测预后的精确LNR。我们收集了2007年至2012年期间到我院就诊的10120例乳腺癌患者的数据，其中包括3936例淋巴结阳性患者（3283例APN(-)患者和653例APN(+)患者）。然后我们应用X-tile分析来计算临界值，并进行生存分析和多因素分析以评估患者的预后。我们证实，一些APN(+)患者根据先前报道的LNR被错误分组，这表明在应用LNR预测预后时应排除APN(+)患者。然后我们应用X-tile分析为LNR-APN(-)患者计算了两个临界值（0.15和0.34），并进行生存分析，发现LNR-APN(-)分期在预测APN(-)乳腺癌患者的预后方面优于pN分期。从这项研究中，我们得出结论，排除APN(+)患者是有效实施LNR系统的最必要条件。LNR-APN(-)分期可能是一种更全面的预测预后和指导临床医生提供准确适当治疗的方法。
