Prognostic Value Of Lymph Nodes Ratio (LNR) On The Survival Of Breast Cancer Patient In The Entire Study Population And Its Different Subtypes:a SEER-based Analysis

Background&objective:Breast cancer is the most common malignant tumor in women,and is one of these tumors which has better prognosis.Deep study on the prognostic factors of breast caner would improve the level of diagnosis and treatment,and lymph node ratio(LNR)is one of these factors.However,few studies focused on the role of LNR in molecular subtypes of breast cancer nowadays.To improve the diagnosis and treatment of this cancer,we further studied prognostic factors and explored the value of LNR on patient's survival based on a SEER database.Methods:We retrospectively analyzed 36593 female breast cancer patients from 2010 to 2013,using the U.S.National Cancer Institute's Surveillance,Epidemiology,and End Results(SEER)database.LNR was classified into 3 groups based on the criterion of Vinh-Hung:low(<0.2),intermediate(02-0.65)and high(>0.65)groups.The Kaplan—Meier plots were used to analyze patient's overall survival(OS)and breast cancer-specific survival(BCSS)both in the whole study population and different molecular subtypes.Additionally,univariate and multivariate analyses were also used to investigate the role of LNR in the survival of breast cancer patients,and further analyses were stratified joint with pathological nodal stage(pN-stage).Results:Our study showed many prognostic factors,including LNR,pN-stage,molecular subtypes,age,race,marital status,tumor size,grade,radiation and chemotherapy and so on.Moreover,LNR and pN-stage were both independent prognostic factors in breast cancer patients(all P-value<0.05).Kaplan—Meier plots indicated that LNR played a great role in patient's outcome and patients with higher LNR have worse survival,no matter in the erntire group or in the different four subtypes.Furthermore,pN-stage showed similar effect on patient's survival except Her-2+/HR-subgroups.Joint with pathological nodal stage,we found that LNR had a great significance on predicting patient's survival in pN2-stage and pN3-stage patients,but no obvious effects were found in pN1-stage patients.Conclusion:LNR is an independent prognostic factor in breast cancer.Moreover,increasing LNR indicates worse outcome in the entire group and its subgroups.The value of LNR is superior to pN-stage in the whole population and especially in the Her-2+/HR-subtype,which means that it should be taken into the management of breast cancer to improve patient outcome.