Ratios of involved nodes in early breast cancer

Breast Cancer Research

Melanie Royce⁴  Guy Storme⁶  Mia Voordeckers⁶  Georges Vlastos¹  Patricia Tai⁵  Jan Van de Steene⁶  Gábor Cserni²  Donald I Promish⁷  Claire Verschraegen⁴  Vincent Vinh-Hung³ 

[1] Gynecologic Oncology and Senology, Geneva University Hospitals, Geneva, Switzerland;Surgical Pathology, Bács-Kiskun County Teaching Hospital, Kecskemét, Hungary;Student Management Healthcare Data, BISI-VUB, Computer Science and Medical Informatics, Vrije Universiteit Brussel, Jette, Belgium;The University of New Mexico, Cancer Research and Treatment Center, Albuquerque, New Mexico, USA;Radiation Oncology, Saskatchewan Cancer Agency, Regina, Canada;Oncology Center, Academic Hospital, AZ-VUB, Vrije Universiteit Brussel, Jette, Belgium;Decision Analyst, Burlington, Vermont, USA

关键词: survival;    staging;    SEER program;    ratio-based prognostic index;    proportion based;    proportional hazards;    prognostic factors;    predictive utility;    Nottingham Prognostic Index;    nodal ratio;    log odds;    loco-regional;    functional form;    breast neoplasm;    axillary lymph node ratio;   

Others  :  1118712
DOI  :  10.1186/bcr934

 received in 2004-03-29, accepted in 2004-08-26,  发布年份 2004

【 摘 要 】

Introduction

The number of lymph nodes found to be involved in an axillary dissection is among the most powerful prognostic factors in breast cancer, but it is confounded by the number of lymph nodes that have been examined. We investigate an idea that has surfaced recently in the literature (since 1999), namely that the proportion of node-positive lymph nodes (or a function thereof) is a much better predictor of survival than the number of excised and node-positive lymph nodes, alone or together.

Methods

The data were abstracted from 83,686 cases registered in the Surveillance, Epidemiology, and End Results (SEER) program of women diagnosed with nonmetastatic T1–T2 primary breast carcinoma between 1988 and 1997, in whom axillary node dissection was performed. The end-point was death from breast cancer. Cox models based on different expressions of nodal involvement were compared using the Nagelkerke R² index (R²_N). Ratios were modeled as percentage and as log odds of involved nodes. Log odds were estimated in a way that avoids singularities (zero values) by using the empirical logistic transform.

Results

In node-negative cases both the number of nodes excised and the log odds were significant, with hazard ratios of 0.991 (95% confidence interval 0.986–0.997) and 1.150 (1.058–1.249), respectively, but without improving R²_N. In node-positive cases the hazard ratios were 1.003–1.088 for the number of involved nodes, 0.966–1.005 for the number of excised nodes, 1.015–1.017 for the percentage, and 1.344–1.381 for the log odds. R²_N improved from 0.067 (no nodal covariate) to 0.102 (models based on counts only) and to 0.108 (models based on ratios).

Discussion

Ratios are simple optimal predictors, in that they provide at least the same prognostic value as the more traditional staging based on counting of involved nodes, without replacing them with a needlessly complicated alternative. They can be viewed as a per patient standardization in which the number of involved nodes is standardized to the number of nodes excised. In an extension to the study, ratios were validated in a comparison with categorized staging measures using blinded data from the San Jose–Monterey cancer registry. A ratio based prognostic index was also derived. It improved the Nottingham Prognostic Index without compromising on simplicity.

【 授权许可】

   
2004 Vinh-Hung et al.; licensee BioMed Central Ltd

【 图 表 】

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