| Objective:Breast cancer(BC):one of the most common malignant tumors among women in China and the world,it is also one of the malignant tumors that endanger women’s health and affect their quality of life.Accurate prediction and assessment of postoperative risk of recurrence and death of breast cancer patients,and the development of more effective individualized treatment programs are of great significance for the survival of patients.Lymph nodes(lymph nodes,the LNs)of the state of the evaluation and prediction is an important index of disease severity and prognosis of breast cancer,in recent years,with domestic and foreign literature and research show that the ratio of axillary lymph nodes(lymph node ratio,LNR)in staging have more advantages than the traditional pN in installment,and LNR proved to be independent prognostic factors of axillary lymph node metastasis of breast cancer patients.This study will explore the relationship between axillary lymph node ratio and prognosis in patients with stage n1-2 breast cancer,so as to provide an effective basis for predicting and evaluating the prognosis of patients with axillary lymph node metastasis of breast cancer and formulating individualized treatment.Methods:Collection of Qingdao municipal hospital from January 2010 to December 2014confirmed by pathology after the operation,axillary lymph node metastasis of 108 patients with invasive breast cancer,collected the clinical data of patients,including The age of the patient,tumor size,histological classification,the number of lymph nodes and lymphatic vessel invasion,presence of cancerous tissue invasion,estrogen receptor,progesterone receptor,its Her-2 expression and p53 and Ki-67 expression,through the study of 108patients were retrospectively analyzed.To investigate the correlation between LNR and overall survival OS in breast cancer patients with axillary lymph node metastasis.All data were processed and analyzed with SPSS 22.0 statistical software.Results:1.LNR was associated with tumor size,histological grade,lymphatic infiltration,number of positive lymph nodes,and lymph node dissection biopsy(p<0.05),but not with the expression of p53(p=0.766>0.05),the age of the patient(p=0.338>0.05),ER(p=0.0.106>0.05),PR(p=0.251>0.05),Her-2(p=0.773>0.05),nerve invasion(p=0.463>0.05),and expression of Ki-67(p=0.234>0.05).2.The single factor analysis results:lymph node ratio(LNR),histological grade,lymph node metastasis positive number,cleaning the total number of lymph node biopsy,ER,PR,expression of Ki-67 were correlated with OS with patients(p<0.05).and age(p=0.678>0.05),tumor diameter size and its Her-2 state(p=0.128>0.05),nerve invasion(p=0.901>0.05),p53(p=0.486>0.05),lymphatic vessel invasion(p=0.081>0.05)had no correlation with OS of the patients.3.The results of multivariate analysis showed that the expression levels of LNR and Ki-67were predictors of OS in patients with positive axillary lymph node metastasis of breast cancer(p<0.05).4.The influence of different groups with positive proportion of axillary lymph nodes on OS:when LNR was less than or equal to 0.2,the median OS was 65 months(95%CI,62.50,70.12).When 2<LNR 0.65,the median OS was 56 months,95%CI(43.94,68.05).When LNR>was 0.65,the median OS OS was 34 months,and the 95%CI was 23.76,44.24.By Log rank test,the result was:χ~2=56.560,p=0.000<0.05.5.The effect of LNR on OS in all groups with positive axillary lymph nodes5.1 the influence of LNR on OS when the number of positive axillary lymph nodes was1-3(pN1 stage):57 patients with breast cancer with 1-3 positive axillary lymph nodes(pN1 stage)were divided into 3 subgroups using 0.2 and 0.65 as the boundary values.53patients when LNR was less than 0.2,4 patients when LNR was less than 0.65,and 0patients when LNR was less than 0.65.When LNR 0.2,the median OS was 75 months;when 2<LNR 0.65,the median OS was 45 months;the Log rank test results were:χ~2=21.570,p=0.356>0.05.5.2 the influence of LNR on OS when the number of positive axillary lymph nodes was4-9(pN2 stage):51 patients with breast cancer with positive axillary lymph nodes(pN2stage)were divided into 3 subgroups,with 0.2 and 0.65 as the boundary values.There were5 patients when LNR was less than 0.2,27 patients when 2<LNR was less than 0.65,and19 patients when LNR>was 0.65.When LNR<0.2,the median OS was 75 months;when2<LNR 0.65,the median OS was 45 months;when LNR>0.65,the median OS was 34months;the Log rank test results were:χ~2=21.570,p=0.000<0.05.Conclusion:1.LNR is related to tumor size,histological grade,lymphatic infiltration,number of positive lymph nodes and lymph node dissection biopsy,and is not related to the expression of p53,age,ER,PR,Her-2,nerve infiltration and Ki-67.2.The expression of LNR and Ki-67 is an important factor for predicting and evaluating the prognosis of patients,and the greater the LNR is,the worse the prognosis will be,and the higher the expression of Ki-67 is,the worse the prognosis will be.3.In the future,LNR may be an important factor to evaluate and predict the prognosis of breast cancer patients with axillary lymph node metastasis,and provide certain basis for effective and individualized treatment selection of postoperative breast cancer patients. |
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