title: Nodal ratio of positive to excised nodes, but not number of positive lymph nodes is better to predict group to avoid chemotherapy among postmenopausal ER-positive, lymph node-positive T1-T2 breast cancer patients.
abstract: OBJECTIVE
  To identify whether nodal ratio (NR) of positive to excised nodes is superior to number of positive lymph nodes to predict group to avoid chemotherapy among postmenopausal ER-positive, lymph node-positive, T1-T2 breast cancer patients.
  
  
  METHODS
  Postmenopausal estrogen receptor (ER)-positive, lymph node-positive patients who received endocrine therapy (n = 173) with complete baseline data in our hospital between 2000 and 2006 were included. The disease-free survival (DFS) was compared. Survival analysis was performed using Kaplan-Meier method. Cox proportional hazard models were used to evaluate the prognostic value of chemotherapy with different NR for DFS. P--values less than 0.05 were regarded as significant.
  
  
  RESULTS
  The median follow-up was 72 months. Three of 13 variables analyzed remained significantly prognostic for survival in the Cox proportional hazards model. These included age (hazard ratio (HR) =1.642, 95% confidence interval (CI) =1.154-2.337, P = 0.006); histological grade (HR = 2.463,95% CI = 1.389-4.367, P = 0.002); and NR (HR = 2.280, 95% CI = 1.113-4.671, P = 0.024). Subgroup analysis by NR status showed that in patients with NR ≥ 0.20, chemotherapy significantly improves DFS (HR = 0.360, 95% CI = 0.195-0.663, P = 0.001); while in patients with NR < 0.20, chemotherapy did not significantly affect DFS (HR = 0.677, 95% CI = 0.227-2.107, P = 0.493). Radiotherapy is an important factor that improves DFS in lymph node-positive patients, so it is considered in all analysis.
  
  
  CONCLUSIONS
  This retrospective analysis demonstrates that NR of positive to excised nodes, but not number of positive lymph nodes is better to predict group to avoid chemotherapy among postmenopausal ER-positive, lymph node-positive T1-T2 breast cancer patients.
authors.forename: X Q
authors.initials: XQ
authors.lastname: Jia
authors.forename: Q
authors.initials: Q
authors.lastname: Hong
authors.forename: J Y
authors.initials: JY
authors.lastname: Cheng
authors.forename: J W
authors.initials: JW
authors.lastname: Li
authors.forename: Y J
authors.initials: YJ
authors.lastname: Wang
authors.forename: M
authors.initials: M
authors.lastname: Mo
authors.forename: Z M
authors.initials: ZM
authors.lastname: Shao
authors.forename: Z Z
authors.initials: ZZ
authors.lastname: Shen
authors.affiliation: Department of Breast Surgery, School of Public Health, Cancer Center and Cancer Institute, Shanghai Medical College, Fudan University, Shanghai, China.
authors.forename: G Y
authors.initials: GY
authors.lastname: Liu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008198:Lymph Nodes / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D009367:Neoplasm Staging; D017698:Postmenopause; D011379:Prognosis; D011960:Receptors, Estrogen / Q000378:metabolism*; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D011960:Receptors, Estrogen