Axillary lymph node ratio and total number of removed lymph nodes: predictors of survival in stage I and II XXXX .

@entity1 @entity0 @entity3
AIMS: Presence of axillary lymph node @entity3 is considered the most important prognostic factor for @entity0 survival. In a period of increasing popularity for the sentinel node procedure, clarity about the possible relation between axillary dissection and survival is essential. This study investigated whether the total number of removed lymph nodes and the ratio of invaded/removed lymph nodes (lymph node ratio (LNR) would prove to be independent prognostic factors for survival. METHODS: Data from 453 consecutive @entity1 with stage I or II @entity0 were studied retrospectively. The total number of removed lymph nodes and the LNR were analysed for their prognostic value in comparison with known prognostic factors. RESULTS: Node-negative @entity1 with < 14 lymph nodes removed had a 10 year survival of 79% compared with 89% in @entity1 with > or = 14 lymph nodes removed (P=0.005). The 10 year survival for @entity1 with an LNR > or = 0.2 was 52%, compared with 73% for @entity1 with an LNR < 0.2 (P<0.0001). A Cox proportional hazards model showed that, for node-negative @entity1 , only age and total number of removed lymph nodes were significant prognostic factors. For node-positive @entity1 , age, total number of removed lymph nodes and the LNR were significant risk factors for survival outcome. The LNR was also significantly associated with the presence of distant @entity3 during follow-up (hazard ratio 3.56, range 1.63-7.77). CONCLUSIONS: In stage I and II @entity0 , a favourable prognosis was found for node-negative @entity1 with > or = 14 removed lymph nodes. Before axillary lymph node dissection with its well-defined survival prognosis is replaced by less invasive staging methods, long-term survival using new staging techniques needs to be defined. For node-positive @entity1 , the LNR proved to be an excellent predictor for survival outcome or development of @entity3 . Selection of lymph node-positive @entity1 based on the LNR may guide specific adjuvant treatment choices.
