ASO：受累淋巴结比值可作为乳腺癌重要预后因素

腋窝淋巴结(LN)的绝对受累数目被视为乳腺癌的最重要预后因素。在过去10年期间，有数项研究表明，在结局预测方面，淋巴结比(LNR)可能优于阳性LN数目。在2013年3月28日在线出版的《外科肿瘤学年鉴》(Annals of Surgical Oncology)杂志上，荷兰内梅亨大学Pim J. M. Dings博士等人发表了最新的一项研究结果，该研究对根据之前发表的LNR界值可用性进行了检测，并对LNR在全国性水平上的预后相关价值进行了考察。
研究人员通过一项基于人口的全国性相关研究，并利用荷兰癌症登记数据库相关数据，对其中于1999年至2005年期间，确诊为淋巴结呈阳性的所有乳腺癌女性患者进行了考察(N = 25,315)。患者被分为3种LNR风险组(低风险组, ≤0.20; 中等风险组, 0.21-0.65; 及高风险组, >0.65)。此外，研究人员进行了Kaplan-Meier生存分析。并通过Cox比例风险模型，评价了LNR与总生存率(OS)的相关性。
研究结果显示，整个患者队列的5年及10年OS率分别为78 % 及 62 %。 LN数目与OS相关(1-3个、4-9个及10个及以上阳性淋巴结患者的5年OS分别为84%, 72 %以及 55 % ，P < .001)。LNR也与OS相关(低风险组、中等风险组以及高风险组的5-year OS 分别为86 %、75 %以及54 % ， P < .001)。多变量分析表明，患者死亡风险随LNR值的增加而增加(P < .001)。
研究人员最终认为，作为传统临床病理因素之外的一种参数，LNR对淋巴结呈阳性的患者具有重要的预后价值。文章建议，应将LNR作为一种独立预后变量增补进入现行分期系统。
与乳腺癌相关的拓展阅读：

• Lancet Oncol：帕妥珠单抗、曲妥珠单抗和多烯紫杉醇方案可作为HER2阳性的转移性乳腺癌患者的标准治疗方案
• JCO：紫杉醇/吉西他滨维持化疗可改善转移性乳腺癌患者生存
• Medpage：他莫西芬或可预防乳腺癌
• AACR2013：他汀类药物可显著降低乳腺癌死亡率
• Ann Surg：肥胖乳腺癌患者术前抗生素预防可降低手术部位感染发生率
• Radiother Oncol：放疗在乳腺癌和前列腺癌患者中的使用有上升趋势
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The Prognostic Value of Lymph Node Ratio in Node-Positive Breast Cancer: A Dutch Nationwide Population-Based Study.
BACKGROUND
The absolute number of involved axillary lymph nodes (LNs) is considered the most important prognostic factor in breast cancer. Over the last decade, several studies indicated that the lymph node ratio (LNR) might predict outcome better than the number of positive LNs. In this study we test the applicability of earlier published LNR cutoff values and study the prognostic value of the LNR on a nationwide level.
METHODS
A nationwide population-based study was performed, using data from the Netherlands Cancer Registry, including all women diagnosed with node-positive breast cancer between 1999 and 2005 (N = 25,315). Patients were divided into 3 LNR risk groups (low, ≤0.20; intermediate, 0.21-0.65; and high, >0.65). Kaplan-Meier survival analysis was performed. In order to evaluate whether LNR was associated with overall survival (OS), Cox proportional hazards modeling was used.
RESULTS
For the entire cohort, 5- and 10-year OS rates were 78 % and 62 %, respectively. The number of positive LNs correlated with OS (5-year OS 84 %, 72 %, and 55 % for patients with 1-3, 4-9, and 10 or more positive LNs, respectively, P < .001). LNR also correlated with OS (5-year OS 86 %, 75 %, and 54 % for low-, intermediate-, and high-risk groups, respectively, P < .001). In the multivariable analysis, the risk of death increased with increasing LNR (P < .001).
CONCLUSIONS
The LNR has an important prognostic value in node-positive patients, independent of traditional clinicopathological factors. LNR should be added as an independent prognostic variable to the current staging system.