Prognostic Correlation Study Of Histological Grade And Lymph Node Metastasis Ratio In Patients With Breast Invasive Ductal Carcinoma

Background:Breast cancer is the most common malignant tumor for women in China and the world,seriously threatening women’s physical and mental health.The histological grade and lymph node metastasis status of breast cancer can help clinicians evaluate and predict the risk of recurrence and metastasis of patients,and develop more accurate and effective individualized treatment regimens,and prolong patients’ lives.For a long time,people have been devoted to studying the relationship between histological grade and tumor biological behavior of breast cancer,to guide clinical treatment and prognostic assessment.Several studies have shown that the histological grade has independent prognostic significance for breast cancer.Lymph node status is also an important indicator in assessing the prognosis of breast cancer patients.The number of lymph nodes removed during breast surgery remain controversial.Studies have shown that the more lymph nodes are removed,the better prognosis of patients have.Although excessive dissection ensures adequate number of lymph nodes,the postoperative related complications will also increase,such as lymphedema,which influence patients’ quality of life severely.Too few lymph node dissection may reduce the N stage of breast cancer,leading patients lose the opportunity of appropriate treatment,which increase the risk of recurrence and death.In addition,it is difficult to standardize the techniques among different operators and pathological detection institutions,which also leads to the inability assessment of the lymph node status accurately.And metastatic lymph node ratio(LNR),the ratio of the number of positive lymph nodes to the total number of lymph nodes,was used to standardize the assessment of lymph node status.Some studies have confirmed that LNR was superior to traditional pN stage in tumor stage.This study will investigate the correlation of histological grade and LNR with prognosis of invasive ductal carcinoma of breast,providing an effective basis for predicting and evaluating the prognosis of breast cancer patients and developing individualized treatment regimens.Methods:Collect the statistics of patients with breast cancer who underwent modified radical mastectomy or radical mastectomy in Qilu Hospital from January 2009 to May 2012,including age,tumor size,histological grade,total number of removed lymph nodes,number of positive lymph nodes,expression of estrogen receptor,progesterone receptor,Her-2 and Ki-67.A retrospective analysis was conducted on 146 patients,Kaplan-Meier method and Cox proportional risk regression model was used to perform the univariate and multivariate statistical survival analysis;Spearman performs correlation analysis between different variables;Chi-square tests or Fisher exact tests perform intergroup difference analysis of different categorical variables.We aim to study the correlation between histological grading,LNR of breast cancer tumors and disease-free survival in patients.All data were processed and analyzed by SPSS26.0 statistical software.Results:1.146 patients with breast cancer after surgery were enrolled in this study,and 135 were followed up successfully with a follow-up rate of 92%.The average disease-free survival of these patients is 81.03±30.60 months;and the 1-year,5-year disease-free survival rates were 95.9%and 82.1%,respectively.2.Multivariate analysis showed that histological grading and LNR had good predictive value for the prognosis of breast cancer patients,and both are independent influencing factors of DFS.Histological grade Ⅲ and LNR>0.2 were independent factors related to shorter DFS.3.Chi-square test showed statistically significant differences in tumor size,ER and PR among breast cancer patients with different histological grades;Spearman correlation analysis showed that histological grade was negatively correlated with the expression of ER and PR,and positively correlated with tumor size.Conclusions:Histological grade and LNR show good predictive value in prognosis in patients with invasive ductal carcinoma of the breast,and both are independent predictors of DFS.Patients with histology grade III or LNR>0.2 have a poor prognosis.LNR has a better predictive prognosis than pN staging.LNR may be used to evaluate the prognosis of invasive ductal carcinoma patients undergoing modified radical mastectomy or radical mastectomy,complementing the current TNM staging system.