Impact of Number of Positive Lymph Nodes and Lymph Node Ratio on Survival of Women with Node-Positive Breast Cancer

Abstract

Objective: This study aimed to evaluate the association of axillary lymph node ratio (LNR) and number of positive lymph nodes (pN) with therisk of breast cancer recurrence and death.Materials and Methods: A retrospective cohort study of node-positive stage II and III breast cancer patients diagnosed and treated between 2008and 2009 at the Brazilian National Cancer Institute (INCA), Brazil. Overall and disease-free survival curves for number of positive lymph nodes (pN)and lymph node ratio (LNR) risk groups were constructed using the Kaplan-Meier method and compared by the log-rank test. Multivariate analysiswas performed using stepwise forward Cox regression models.Results: In total, 628 women with node-positive breast cancer were included. Most patients (69.5%) had advanced clinical stage tumors (≥IIB).The median follow-up was 58 months (range: 3‒92 months). The adjusted recurrence hazard of pN2 and pN3 patients was 2.47 (95% ConfidenceInterval [CI] 1.72-3.56) and 2.42 (1.62-3.60), respectively, compared to pN1 patients (p0.65) LNR was 2.11 (1.49-3.00) and 3.19 (2.12-4.80), respectively, compared to low-risk LNR (≤0.20) patients (p