148 Metastatic lymph node ratio: independent prognostic factor for disease free survival in node positive breast cancer

17 Background: Recommendations for extended lymphadenectomy in gastric cancer is thought to be associated with improved overall survival (OS), although defining adequate lymphadenectomy remains controversial. Methods: A single-institution, prospectively-maintained database of patients referred for surgical care of gastric cancer was reviewed. Patients were stratified by number of examined lymph nodes (eLN): <5, 6-10, 11-15, and >15 and positive LNs (LN+) stratified by 0, 1-2, 3-6, 7-15, and >15. Lymph node ratio (LN+:eLN) was evaluated, stratified by 0, 0.01-0.2, 0.21-0.5, and >0.5. Disease-free-survival (DFS) and OS were the primary endpoints, determined by Kaplan-Meier analyses. Results: From 1997-2012, 222 patients were included; most were male (N=122, 55%) with median age 67 (range 17-92) years. Of 220 (99%) patients surgically explored, 164 (74%) ultimately underwent resection. Median OS of the entire cohort was 22 months. Gender, ethnicity, and smoking status did not impact OS. Pathologic factors such as perineural invasion, lymphovascular invasion, and poor differentiation adversely affected OS, P<0.05. A median 14 lymph nodes (LN) were retrieved (range 0-45), with a median of one positive LN (range 0-31). No OS or disease-free survival (DFS) difference was observed when comparing <5, 6-10, 11-15, and >15 eLN, P=0.30. LN+ affected both OS and DFS: median OS was 52 months for 0 LN+ and decreased to 21 months with 1-2 LN+, 34 months 3-6 LN+, 25 months 7-15 LN+, and 11.5 months with >15 LN+. Similarly, median DFS decreased from 35 months with 0 LN+ to 19 months with 1-2 LN+, 9 months with 3-6 LN+, 13.5 months with 7-15 LN+, and 7.5 months with >15 LN+. Lymph node ratio demonstrated worse median OS with increasing ratio: 49 months for ratio of 0, 37 months for 0.01-0.2, 27 months for 0.21-0.5, and 12 months for >0.5, P<0.0001. DFS was similar: 35months for ratio of 0, 22 months for 0.01-0.2, 13 months for 0.21-0.5, and 7 months for >0.5, P<0.0001. Conclusions: Extent of lymphadenectomy does not impact OS or DFS. Presence of LN+ adversely impacts OS and DFS. Lymph node ratio may be a better prognostic indicator than number of eLN or LN+ in gastric cancer.

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549 poster The lymph node ratio as prognostic factor in node-positive breast cancer

Radiotherapy and Oncology ◽

10.1016/s0167-8140(04)82417-4 ◽

2004 ◽

Vol 73 ◽

pp. S243-S244

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Prognostic Factor ◽

Lymph Node Ratio ◽

Node Positive ◽

Node Ratio ◽

Positive Breast Cancer

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Neoadjuvant Chemotherapy with Docetaxel, Carboplatin and Weekly Trastuzumab Is Active in HER2-Positive Early Breast Cancer: Results after a Median Follow-Up of over 4 Years

Breast Care ◽

10.1159/000452079 ◽

2016 ◽

Vol 11 (5) ◽

pp. 323-327 ◽

Cited By ~ 1

Author(s):

Hans-Christian Kolberg ◽

Leyla Akpolat-Basci ◽

Miltiades Stephanou ◽

Bahriye Aktas ◽

Carla Verena Hannig ◽

...

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Neoadjuvant Therapy ◽

Disease Free Survival ◽

Her2 Positive ◽

Free Survival ◽

Her2 Positive Breast Cancer ◽

Disease Free ◽

Positive Breast Cancer

Introduction: Most patients with HER2-positive breast cancer receive chemotherapy and trastuzumab. Data from adjuvant trials have shown that the combination of docetaxel, carboplatin and weekly trastuzumab (TCH) is well tolerated and as effective as anthracycline-containing regimes. Previous investigations on neoadjuvant treatment with taxanes, platinum salts and trastuzumab showed pathological complete remission (pCR) rates between 43.3 and 76%. To date, the longest published follow-up in this indication is 3 years. Here we present 4-year follow-up data for a cohort of 78 patients treated with neoadjuvant TCH. Methods: Between 2009 and 2014 we treated 78 patients with operable HER2-positive breast cancer with a neoadjuvant schedule of docetaxel (75 mg/m2) and carboplatin (AUC 6) every 3 weeks (q3w) and trastuzumab (4 mg/kg loading dose then 2 mg/kg) q1w. Lymph node involvement was verified by sentinel lymph node or core-cut biopsy. Patients were diagnosed at a mean age of 55.5 years; 65.4% had hormone receptor-positive tumors, 34.6% presented with grade 3 disease and 51.3% of patients were node positive. Patients were monitored every 2 cycles by ultrasound. After 6 cycles of chemotherapy all patients had surgery. Axillary dissection was performed in case of positive lymph node status prior to TCH. After surgery, trastuzumab was continued q3w up to 1 year. Results: No grade III/IV toxicities occurred and no case of congestive heart failure was observed. Neither dose modifications nor dose delays were necessary. 34 of the 78 patients (43.6%) achieved a pCR, 27 of the 40 node-positive patients (67.5%) experienced nodal conversion. After a median follow up of 48.5 months the disease-free survival (DFS) was 84.6%, the distant disease-free survival (DDFS) was 87.2% and the overall survival (OS) was 91%. Only T stage and nodal status at baseline were found to be significantly associated with survival estimates. Conclusion: The anthracycline-free regimen TCH is effective and safe in the neoadjuvant therapy of HER2-positive breast cancer, yielding DFS, DDFS and OS probabilities comparable to the results of adjuvant trials. Our data support the use of TCH as a neoadjuvant therapy regimen for patients with HER2-positive breast cancer. They also strongly encourage the use of taxanes and platinum salts as the chemotherapy backbone in studies investigating dual blockade with trastuzumab and pertuzumab in the neoadjuvant setting.

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The Prognostic Significance of Modified Lymph Node Ratio and LODDS in HER-2(+) Breast Cancer

The Journal of Tepecik Education and Research Hospital ◽

10.5222/terh.2021.92259 ◽

2021 ◽

Author(s):

Fatma Özkan ◽

Ilkay Tugba Unek ◽

Olçun Ümit Ünal ◽

Mustafa Emiroğlu ◽

Asım Leblebici ◽

...

Keyword(s):

Breast Cancer ◽

Lymph Node Ratio ◽

Prognostic Significance ◽

Disease Free Survival ◽

Risk Groups ◽

Free Survival ◽

Node Ratio ◽

Her 2 ◽

The Mean ◽

Disease Free

Objective: The overexpression of human epidermal growht factor-2 (HER-2) receptor is detected in 20% of patients with breast cancer. The prognosis is poor in patients with HER-2(+) breast cancer not receiving systemic therapy. Modified lymph node ratio (mLNR) and log odds of positive lymph nodes (LODDS) are the novel ratio-based classifications of lymph nodes in breast cancer. In literatüre, the data about the prognostic significance of mLNR ve LODDS is limited in patients with HER-2(+) breast cancer. The objective of the study was to evaluate the prognostic significance of mLNR and LODDS in patients with HER-2(+) breast cancer. Method: This study included 75 patients who were treated with adjuvant chemotherapy and trastuzumab for the diagnosis of HER-2(+) breast cancer between 2008-2013. The patients who received neoadjuvant chemotherapy or patients without axillary dissection were excluded from the study. Results: The mean disease-free survival and overall survival were 126.36±4.38 months (range: 117.78-134.95) and 128.87±3.32 months (range: 122.37-135.38), respectively. The mean disease-free survival was 127.30 months in patients with mLNR≤ 0.5 and 118.08 months in patients with mLNR> 0.5 (p=0.690). When the patients were classified into three groups according to LODDS values as LODDS1 (LODDS≤ -1.0), LODDS2 (-1.0<LODDS≤0) and LODDS3 (LODDS>0), the mean disease-free survival were 128.65 months, 114.07 months and 111.78 months, respectively (p=0.641). Conclusion: In this study, patients with HER-2(+) breast cancer were divided into risk groups according to mLNR and LODDS values, and a survival difference that could be clinically meaningful was observed between the groups, but was not statistically significant. There is a need for studies involving more patients on this subject. Our study highlights the prognostic significance of mLNR and LODDS in HER-2(+) breast cancer. Dividing HER-2(+) breast cancer into risk groups through mLNR and LODDS will help clinicians to develop optimal treatment and follow-up strategies.

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Efficacy of capecitabine and oxaliplatin versus S-1 as adjuvant chemotherapy in gastric cancer after D2 lymph node dissection.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.4_suppl.160 ◽

2019 ◽

Vol 37 (4_suppl) ◽

pp. 160-160

Author(s):

Kabsoo Shin ◽

In-Ho Kim

Keyword(s):

Gastric Cancer ◽

Lymph Node ◽

Adjuvant Chemotherapy ◽

Lymph Node Ratio ◽

Disease Free Survival ◽

Stage Iiic ◽

Free Survival ◽

D2 Lymph Node Dissection ◽

Node Ratio ◽

Disease Free

160 Background: The aim of this study is to compare capecitabine and oxaliplatin (XELOX) with S-1 based on disease-free survival, and to define the clinical impact of lymph node ratio to select a regimen. Methods: Patients who had curative resection and received either S-1 or XELOX as adjuvant chemotherapy for gastric cancer between Jan. 2011 and Dec. 2015, were analyzed using propensity score matching (PSM). Of the 412 patients enrolled, 301 received S-1 and 111 received XELOX and after PSM, the sample size of each group was 111 patients. And the groups were classified according to stage and lymph node ratio (0, > 0-0.1, > 0.1-025, > 0.25) and three-year disease-free survival (DFS) was evaluated. Results: In post-PSM analysis of all 222 patients, The three-year DFS rates in XELOX group was higher than in the S-1 group in all stage 3 (78% vs. 66.1%, p = 0.036), stage IIIC (64.1% vs. 42.0%, p = 0.038) and LNR > 0.25 (67.7.1% vs. 26.1%, p = 0.002). The hazard ratio of XELOX for recurrence compared with S-1 for stage IIIC and LNR > 0.25 was respectively 0.479 (95% CI 0.238~0.985, p = 0.046) and 0.351 (95% CI 0.162~0.758, p = 0.008). Conclusions: Adjuvant XELOX was more effective than S-1 for stage IIIC and LNR > 0.25 in gastric cancer after D2 dissection.

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Hepatic Artery Lymph Node in Pancreatic Cancer: A Retrospective Analysis of Survival Outcomes

10.21203/rs.3.rs-865990/v1 ◽

2021 ◽

Author(s):

Danny Conde ◽

Carlos Rey ◽

Manuel Pardo ◽

Andrea Recaman ◽

Juan Carlos Sabogal Olarte

Keyword(s):

Pancreatic Cancer ◽

Overall Survival ◽

Lymph Node ◽

Hepatic Artery ◽

Vascular Invasion ◽

Lymph Node Ratio ◽

Disease Free Survival ◽

Free Survival ◽

Node Ratio ◽

Disease Free

Abstract BackgroundAfter optimal management, 5 years survival of pancreatic cancer is 12 - 15%. Factors associated with poor prognosis are tumoral histology, harvested regional lymph nodes, and recently, hepatic artery lymph node HLA(8a) involvement. In fact, evidence has shown negative impact of node 8a involvement on overall survival and disease free-survival. Therefore, we aimed to describe the prognostic significance of the HLA(8a) lymph node metastasis in terms of disease-free survival (DFS) and overall survival (OS) on a specific cohort of patients.MethodsA retrospective study was conducted based on a prospective database from the HPB department of patients who underwent a pancreaticoduodenectomy (PD) due to pancreatic cancer during 2014 - 2021. Overall survival (OS) and disease-free survival (DFS) were estimated to be associated with positive HLA(8a) using Kaplan-Meier analysis. Log Rank test and Cox proportional hazards regression analysis were used. Results111 patients were included, 55,4% female. The most frequent pathology was ductal adenocarcinoma (60.3%). Positive rate of the HLA(8a) node was 21.62%. Median OS time was 25.5 months, and median DFS time was 13,8 months. Positive HLA(8a) node, the cutoff of lymph node ratio (LNR) resection, and vascular invasion showed a strong association with OS. (CoxRegression p = 0.03 HR 0.5, p 0.003 HR = 1.8, p = 0.02 HR 0.4 CI 95%). In terms of DFS, lymph node ratio cutoff, tumoral size, and vascular invasion showed a statistically significant association with the outcome (p = 0.008, HR = 1.5; p= 0.04 HR=2.1; p=0.02 HR=0.4 CI 95%).Conclusion In this series of pancreaticoduodenectomies, OS and DFS are significantly reduced in patients with HLA(8a) node compromise in patients with pancreatic cancer. In multivariate analysis, lymph node status remains an independent predictor of OS and DFS. Further studies are needed.

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