title: Nodal Ratio as a Prognostic Factor in Patients with Four or More Positive Axillary Nodes Treated with Breast-conserving Therapy and Regional Nodal Irradiation.
abstract: OBJECTIVE
  This study aimed to investigate the prognostic value of the axillary lymph node ratio (i.e. positive axillary nodes to nodes removed) in patients with breast cancer treated with conservative surgery and regional radiotherapy.
  
  
  METHODS
  We retrieved the records of 195 patients with breast cancer with pathological stage pT1-2 pN2-3, treated from January 2005 to December 2013 at our Radiation Oncology Centers; their clinical data were retrospectively evaluated. All patients underwent lumpectomy or quadrantectomy with axillary lymph node dissection, adjuvant chemo-with/without hormonal therapy and irradiation to the whole breast and ipsilateral axillary apex, infraclavicular and supraclvicular nodes, excluding internal mammary nodes. The primary end-point was to evaluate the nodal ratio as a prognostic factor; moreover, the following prognostic factors were evaluated: age, biological status and molecular profile.
  
  
  RESULTS
  The median follow-up was 58 months (range=32-117.6 months). Two- and 5-year overall and recurrence-free survival rates were 96% and 88%, and 92% and 85%, respectively. On univariate analysis, factors influencing overall survival were nodal ratio >0.65 (p=0.033) and age (p=0.023); time to recurrence was detrimentally impacted only by Ki67 positivity ≥50% (p=0.049). At multivariate analysis, no significant associations were found.
  
  
  CONCLUSIONS
  Adding irradiation to regional nodes after conservative surgery in patients with breast cancer with more than three positive axillary nodes does not alter the prognostic value of the nodal ratio, and we confirm this to be an important factor for predicting overall survival.
authors.affiliation: Operative Unit of Radiation Oncology, G. Martino University Hospital, Messina, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Iatì
authors.affiliation: Operative Unit of Radiation Oncology, G. Martino University Hospital, Messina, Italy apontoriero@unime.it.
authors.forename: Antonio
authors.initials: A
authors.lastname: Pontoriero
authors.affiliation: Department of Biomedical and Dental Sciences and of Morphological and Functional Images, University of Messina, Messina, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Mondello
authors.affiliation: Operative Unit of Radiation Oncology, Papardo - Piemonte Hospital, Messina, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Santacaterina
authors.affiliation: Operative Unit of Radiation Oncology, Papardo - Piemonte Hospital, Messina, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Platania
authors.affiliation: Operative Unit of Radiation Oncology, San Vincenzo Hospital, Taormina, Italy.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Frosina
authors.affiliation: Operative Unit of Radiation Oncology, San Vincenzo Hospital, Taormina, Italy.
authors.forename: Marilena Mattace
authors.initials: MM
authors.lastname: Raso
authors.affiliation: Department of Biomedical and Dental Sciences and of Morphological and Functional Images, University of Messina, Messina, Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Aiello
authors.affiliation: Department of Biomedical and Dental Sciences and of Morphological and Functional Images, University of Messina, Messina, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Arcudi
authors.affiliation: Operative Unit of Radiation Oncology, G. Martino University Hospital, Messina, Italy.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Arena
authors.affiliation: Medicine School, University of Messina, Messina, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Marino
authors.affiliation: Department of Biomedical and Dental Sciences and of Morphological and Functional Images, University of Messina, Messina, Italy.
authors.forename: Micol
authors.initials: M
authors.lastname: Mazzei
authors.affiliation: Department of Biomedical and Dental Sciences and of Morphological and Functional Images, University of Messina, Messina, Italy.
authors.forename: Carmen
authors.initials: C
authors.lastname: Rifatto
authors.affiliation: Department of Biomedical and Dental Sciences and of Morphological and Functional Images, University of Messina, Messina, Italy.
authors.forename: Edoarda
authors.initials: E
authors.lastname: Risoleti
authors.affiliation: Medicine School, University of Messina, Messina, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Runco
authors.affiliation: Operative Unit of Radiation Oncology, G. Martino University Hospital, Messina, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Sansotta
authors.affiliation: Operative Unit of Radiation Oncology, G. Martino University Hospital, Messina, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Delia
authors.affiliation: Department of Biomedical and Dental Sciences and of Morphological and Functional Images, University of Messina, Messina, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Sindoni
authors.affiliation: Department of Biomedical and Dental Sciences and of Morphological and Functional Images, University of Messina, Messina, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Pergolizzi
mesh_terms: D000368:Aged; D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology / Q000628:therapy*; D018270:Carcinoma, Ductal, Breast / Q000556:secondary / Q000628:therapy*; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D015412:Mastectomy, Segmental; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016896:Treatment Outcome; D047368:Tumor Burden
keywords: Early breast cancer; nodal ratio; prognostic factors; radiotherapy