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      Lymph Node Ratio as a Good Prognostic Factor for Patients with Pathologic N3a Breast Cancer with 10 or More Metastatic Axillary Lymph Nodes

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      https://www.riss.kr/link?id=A107956007

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      다국어 초록 (Multilingual Abstract)

      Purpose: Pathologic N3a breast cancer is defined as having 10 or more metastatic axillary lymph nodes and metastases to the infraclavicular (level III axillary lymph) node. This study aimed to determine clinicopathological factors and assess the importance of lymph node ratio (LNR) as a prognostic factor for patient with N3a breast cancer treated with surgery without neoadjuvant chemotherapy. Methods: Medical records of 154 patients who underwent surgery were retrospectively analyzed. Patients were pathologically diagnosed with N3a breast cancer between May 2004 and December 2014. LNR was defined as the number of metastatic lymph nodes divided by the total number of resected lymph nodes. It was calculated using the receiver operating characteristic (ROC) curve. The median follow up period was 94 months (range, 10–205 months). Results: Among 154 patients with N3a breast cancer, 70 (45.5%) had recurrence and 40 (26.0%) died during the follow-up period. The 5-year disease free survival (DFS) and overall survival (OS) rates after surgery were 63.0% and 85.9%, respectively. LNR>0.82 (hazard ratio [HR]: 2.271; 95% confidence interval [CI]: 1.413–3.649; p=0.001) was a prognostic factor significantly associated with DFS. LNR>0.68 (HR: 2.156; 95% CI: 1.146–4.044; p=0.017) and invasive ductal carcinoma (HR: 0.125; 95% CI: 0.017–0.915: p=0.041) were significantly associated with OS. Conclusion: Although LNR values associated with DFS and OS are slightly different, LNR is a good prognostic factor for patients with N3a breast cancer.
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      Purpose: Pathologic N3a breast cancer is defined as having 10 or more metastatic axillary lymph nodes and metastases to the infraclavicular (level III axillary lymph) node. This study aimed to determine clinicopathological factors and assess the impor...

      Purpose: Pathologic N3a breast cancer is defined as having 10 or more metastatic axillary lymph nodes and metastases to the infraclavicular (level III axillary lymph) node. This study aimed to determine clinicopathological factors and assess the importance of lymph node ratio (LNR) as a prognostic factor for patient with N3a breast cancer treated with surgery without neoadjuvant chemotherapy. Methods: Medical records of 154 patients who underwent surgery were retrospectively analyzed. Patients were pathologically diagnosed with N3a breast cancer between May 2004 and December 2014. LNR was defined as the number of metastatic lymph nodes divided by the total number of resected lymph nodes. It was calculated using the receiver operating characteristic (ROC) curve. The median follow up period was 94 months (range, 10–205 months). Results: Among 154 patients with N3a breast cancer, 70 (45.5%) had recurrence and 40 (26.0%) died during the follow-up period. The 5-year disease free survival (DFS) and overall survival (OS) rates after surgery were 63.0% and 85.9%, respectively. LNR>0.82 (hazard ratio [HR]: 2.271; 95% confidence interval [CI]: 1.413–3.649; p=0.001) was a prognostic factor significantly associated with DFS. LNR>0.68 (HR: 2.156; 95% CI: 1.146–4.044; p=0.017) and invasive ductal carcinoma (HR: 0.125; 95% CI: 0.017–0.915: p=0.041) were significantly associated with OS. Conclusion: Although LNR values associated with DFS and OS are slightly different, LNR is a good prognostic factor for patients with N3a breast cancer.

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      참고문헌 (Reference)

      1 Spronk PER, "Variation in use of neoadjuvant chemotherapy in patients with stage III breast cancer : results of the Dutch national breast cancer audit" 36 : 34-38, 2017

      2 Luo SP, "Validation of the prognostic significance of the prognostic stage group according to the eighth edition of American Cancer Joint Committee on Cancer Staging System in triple-negative breast cancer: an analysis from surveillance, epidemiology, and end results 18 database" 247 : 211-219, 2020

      3 Dent R, "Triple-negative breast cancer : clinical features and patterns of recurrence" 13 : 4429-4434, 2007

      4 Jae-Myung Kim, "The prognosis factors among breast cancer patients with extensive axillary lymph node meta" 대한종양외과학회 14 (14): 43-47, 2018

      5 Liao Y, "The positive lymph node ratio predicts survival in T1-4N1-3M0 non-small cell lung cancer : a nomogram using the SEER database" 10 : 1356-, 2020

      6 He M, "The lymph node ratio as an independent prognostic factor for node-positive triple-negative breast cancer" 8 : 44870-, 2017

      7 Gonçalves Jr H, "Survival study of triple-negative and non–triple-negative breast cancer in a Brazilian cohort" 12 : 1179554918790563-, 2018

      8 Nusbaum DJ, "Significance of lymph node ratio on survival of women with borderline ovarian tumors" 301 : 1289-1298, 2020

      9 김윤영, "Prognostically Distinctive Subgroup in Pathologic N3 Breast Cancer" 한국유방암학회 19 (19): 163-168, 2016

      10 Noh JM, "Prognostic significance of nodal involvement region in clinical stage IIIc breast cancer patients who received primary systemic treatment, surgery, and radiotherapy" 24 : 637-641, 2015

      1 Spronk PER, "Variation in use of neoadjuvant chemotherapy in patients with stage III breast cancer : results of the Dutch national breast cancer audit" 36 : 34-38, 2017

      2 Luo SP, "Validation of the prognostic significance of the prognostic stage group according to the eighth edition of American Cancer Joint Committee on Cancer Staging System in triple-negative breast cancer: an analysis from surveillance, epidemiology, and end results 18 database" 247 : 211-219, 2020

      3 Dent R, "Triple-negative breast cancer : clinical features and patterns of recurrence" 13 : 4429-4434, 2007

      4 Jae-Myung Kim, "The prognosis factors among breast cancer patients with extensive axillary lymph node meta" 대한종양외과학회 14 (14): 43-47, 2018

      5 Liao Y, "The positive lymph node ratio predicts survival in T1-4N1-3M0 non-small cell lung cancer : a nomogram using the SEER database" 10 : 1356-, 2020

      6 He M, "The lymph node ratio as an independent prognostic factor for node-positive triple-negative breast cancer" 8 : 44870-, 2017

      7 Gonçalves Jr H, "Survival study of triple-negative and non–triple-negative breast cancer in a Brazilian cohort" 12 : 1179554918790563-, 2018

      8 Nusbaum DJ, "Significance of lymph node ratio on survival of women with borderline ovarian tumors" 301 : 1289-1298, 2020

      9 김윤영, "Prognostically Distinctive Subgroup in Pathologic N3 Breast Cancer" 한국유방암학회 19 (19): 163-168, 2016

      10 Noh JM, "Prognostic significance of nodal involvement region in clinical stage IIIc breast cancer patients who received primary systemic treatment, surgery, and radiotherapy" 24 : 637-641, 2015

      11 Koca E, "Outcomes of locally advanced breast cancer patients with ≥ 10 positive axillary lymph nodes" 30 : 615-, 2013

      12 Perou CM, "Molecular portraits of human breast tumours" 406 : 747-752, 2000

      13 Jin ML, "Modified lymph node ratio improves the prognostic predictive ability for breast cancer patients compared with other lymph node staging systems" 49 : 93-100, 2020

      14 허민희, "Metastatic axillary node ratio predicts recurrence and poor long-term prognosis in patients with advanced stage IIIC (pN3) breast cancer" 대한외과학회 92 (92): 340-347, 2017

      15 Fidalgo F, "Lymphovascular invasion and histologic grade are associated with specific genomic profiles in invasive carcinomas of the breast" 36 : 1835-1848, 2015

      16 Sakin A, "Lymph node ratio predicts long-term survival in lymph node-positive breast cancer" 16 : 270-, 2020

      17 De la Cruz Ku GA, "Lymph node ratio as best prognostic factor in triple negative breast cancer patients with residual disease after neoadjuvant chemotherapy" 26 : 1659-1666, 2020

      18 Cetin IA, "Lymph node ratio as an independent prognostic factor for breast cancer-related mortality in patients with node-positive breast cancer" 16 : 1387-, 2020

      19 Liu D, "Lymph node ratio and breast cancer prognosis : a meta-analysis" 21 : 1-9, 2014

      20 김상원, "Lymph Node Ratio as a Risk Factor for Locoregional Recurrence in Breast Cancer Patients with 10 or More Axillary Nodes" 한국유방암학회 19 (19): 169-175, 2016

      21 Grassadonia A, "Long-term outcome of breast cancer patients with pathologic N3a lymph node stage" 32 : 79-86, 2017

      22 Tonellotto F, "Impact of number of positive lymph nodes and lymph node ratio on survival of women with node-positive breast cancer" 15 : 76-, 2019

      23 Schwartz AM, "Histologic grade remains a prognostic factor for breast cancer regardless of the number of positive lymph nodes and tumor size : a study of 161 708 cases of breast cancer from the SEER program" 138 : 1048-1052, 2014

      24 Man Hung, "Evaluating the Prediction of Breast Cancer Survival Using Lymph Node Ratio" 한국유방암학회 21 (21): 315-320, 2018

      25 김재호, "Clinical significance of the lymph node ratio in N1 breast cancer" 대한방사선종양학회 35 (35): 227-232, 2017

      26 Ai X, "Clinical outcomes of N3 breast cancer : a real-world study of a single institution and the US surveillance, epidemiology, and end results(SEER)database" 12 : 5331-, 2020

      27 홍세리, "Cancer Statistics in Korea: Incidence, Mortality, Survival, and Prevalence in 2018" 대한암학회 53 (53): 301-315, 2021

      28 Fallahpour S, "Breast cancer survival by molecular subtype : a population-based analysis of cancer registry data" 5 : E734-9, 2017

      29 강상율, "Breast Cancer Statistics in Korea in 2017: Data from a Breast Cancer Registry" 한국유방암학회 23 (23): 115-128, 2020

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