One of the most important prognostic factors that predict survival, and used for guiding the treatment plan in TNBC; is the axillary lymph nodes status. Recent studies have shown the impact of lymph node ratio (LNR) and number of negative lymph nodes (NLNs) on the prognosis of breast cancer patients besides, positive nodal affection (PLN). In our study, we try to deeply investigate the impact of LNR and the NLNs on both DFS and OS in TNBC patients as independent novel prognostic factors.
92 female patients TNBC, in Clinical Oncology department, Assuit University; Egypt. Older than 18 years, underwent (MRM) or (BCS) with axillary dissection from 2014 - 2019, they FU till 2021. LNR is defined as the number of positive lymph nodes divided by the total number of lymph nodes removed. SPSS version 26.0 used for descriptive statistics, Weka package tool used to discretize cut off value for LNR, NLNs. A multinomial logistic regression is constructed to ensure the ability of those discretized variables to predict survival. Primary end point was evaluating the relation between LNR and NLNs with DFS and OS & the secondary was a trial to estimate the number of NLNs that can be used as guidance to predict survival outcomes.
Of 92 patients, The mean age was 49.45± SD11.75 & the median number of total LN removed was 12.3 ±SD 3.689, and, the median number of the PLN was 5±SD 4.751. MRM was the commonest done in 72 (78.3%). The most common T &N stage were: T2 in 59 (64.13%) & N2 in 27 (29.3%). Person correlation was significantly positive between DFS and NLNs (P = 0.001), while significantly negative LNR (P=0.002). The best LNR cut-off value by WEKA test was 0.19, while NLDs was 9. We found that Patients having LNR ≤ 0.19 or those with NLNs > 9 had longer DFS >24m (52%) (58%) respectively compared to those LNR >0.19 or NLNs ≤ 9. In addition, a multinominal regression test used to validate quality of them to predict DFI, concluding that having LNR≤ 0.19 and NLNs ≤ 9 associated with increase survival with P= 0.008 & 0.004 respectively. Regarding OS, it was found that both significantly affect OS (p = 0.006, 0.032) respectively.
New independent prognostic factors in TNBC are LNR and NLNs . Further multicentric researches are needed to standardize it, and a trial to be included in an international precision scoring model for survival.
Assuit Clinical Oncology Department, Faculty of Medicine.
Has not received any funding.
All authors have declared no conflicts of interest.