Prognostic Role Of Positive Regional Lymph Node Ratio In Micro-invasive Breast Cancer Patients

Objective:The prognostic value of regional lymph node biopsy and regional lymph node positive ratio in patients with micro-invasive breast cancer(MIBC)has been debated.The aim of this study was to investigate whether patients with MIBC can benefit from regional lymph node biopsy and the predictive value of positive lymph node ratio(PLNR)for the prognosis of regional lymph node-positive micro-invasive breast cancerMethods:Patients diagnosed with micro-invasive breast cancer from 2004 to 2015 were screened from the SEER database,progenisty-score matching(PSM)was conduted to evaluate the prognostic role of regional lymph node of MIBC patients;X-tile software was used to calculate the best cut-off value of PLNR.Survival analysis was performed in MIBC patients with positive axillary lymph nodes using the Kaplan-Meier method and Cox proportional hazards regression model.Results:Regional lymph node biopsy was associated with a benefit in overall survival(p<0.001)but not in breast cancer-specific survival(p=0.254)in MIBC patients.The PLNR had prognostic predictive values of 0.16 and 0.88 for overall survival,0.22 and 0.88 for breast cancer-specific survival,respectively.Univariate analysis of MIBC patients with positive regional lymph nodes showed that age(p<0.001),positive lymph node ratio(p<0.001),number of positive lymph nodes(p<0.001),and chemotherapy(p=0.004)were associated with overall survival in micro-invasive breast cancer.Prognostic factors associated with breast cancer-specific survival included tumor Grade(p=0.007),positive lymph node ratio(p<0.001),number of positive lymph nodes(p<0.001).Multivariate hazard regression model analysis suggested that independent prognostic factors for overall survival included age(p<0.001,HR(95%CI=3.088(1.733-5.502)),tumor Grade(Grade ?-? vs.Grade ?,p=0.043,HR(95%CI=1.804(1.020-3.192)),PLNR(1-3 vs.4-9,p=0.038,HR(95%CI)=(2.590(1.53-6.368),1-3 vs.?10,p=0.005,HR(95%CI=3.453(1.457-8.187)),PLNR(1?0.16 vs.0.89-1.00,p=0.001,HR(95%CI)=3.844(1.728-8.552)),chemotherapy or not(p=0.015,HR(95%CI)=(2.080(1.151-3.759)).Independent prognostic factors for breast cancer-specific survival included tumor grade(Grade ?-? vs.Grade ?,p=0.006,HR(95%CI=2.869(1.355-6.071)),PLNR(?0.22 vs.0.89-1.00,p=0.005,HR(95%CI)=3.859(1.516-9.822)),number of positive lymph nodes(1-3 vs.4-9,p=0.013,HR(95%CI)=(4.643(1.379-15.632)),1-3 vs.?10,p=0.001,6.184(2.240-17.866))and chemotherapy or not(p=0.016,HR(95%CI)=(2.623(1.193-5.767)).Conclusions:Regional lymph node biopsy is a significant survival benefit for micro-invasive breast cancer patients of OS.In multivariate analysis,predictors of OS include age,PLNR,the number of positive lymph node and chemotherapy,while predictors of BCSS include PLNR,the number of positive lymph node and chemotherapy.PLNR=0.88 is a vital prognostic factor for MIBC patients.The prognostic value of number of positive lymph nodes is superior to PLNR of MIBC.