This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Woodward, W. A. Articles by Nieto, Y. Search for Related Content PubMed PubMed Citation Articles by Woodward, W. A. Articles by Nieto, Y. Social Bookmarking                            What's this?

Prognostic Value of Nodal Ratios in Node-Positive Breast Cancer

Wendy A. Woodward, Vincent Vinh-Hung, Naoto T. Ueno, Yee Chung Cheng, Melanie Royce, Patricia Tai, Georges Vlastos, Anne Marie Wallace, Gabriel N. Hortobagyi, Yago Nieto

From the Departments of Radiation Oncology, Breast Medical Oncology, and Blood and Marrow Transplantation, University of Texas M.D. Anderson Cancer Center, Houston, TX; Oncology Center and Management of Healthcare Data, Biostatistics and Medical Informatics, Vrije Universiteit Brussel, Jette, Belgium; Department of Oncology, Medical College of Wisconsin, Milwaukee, WI; Departments of Internal Medicine, Hematology/Oncology, and Surgery, University of New Mexico Cancer Research and Treatment Center, Albuquerque, NM; Department of Radiation Oncology, Allan Blair Cancer Center, Regina, Canada; Departments of Obstetrics and Gynecology, Senology, and Gynecologic Oncology, Geneva University Hospitals, Geneva, Switzerland; and the Department of Hematology, Clinica Universitaria de Navarra, Pamplona, Spain

Address reprint requests to Wendy A. Woodward, MD, PhD, Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Unit 97, Houston, TX 77030; e-mail: wwoodward{at}mdanderson.org

PURPOSE: The American Joint Committee on Cancer staging system for breast cancer was recently updated to reflect the impact of increasing the absolute number of positive lymph nodes on prognosis. However, numerous studies suggest that nodal ratios (absolute number of involved nodes–number of nodes resected) may have greater prognostic value than absolute numbers of involved nodes. Here we examine the data supporting the use of nodal ratios in breast cancer prognosis and consider the potential advantages and disadvantages of including nodal ratios in breast cancer staging.

METHODS: A systematic review of the literature was conducted using the following search engines: http://www.google.com; Thomson's ISI Web of Science; PubMed.

RESULTS: In multiple reports from both prospective and retrospectively collected data sets, nodal ratios have been shown to be significant predictors of outcome, including locoregional recurrence and overall survival. These studies span all stages of breast cancer and include various treatments as well as various statistical approaches.

CONCLUSION: There is considerable data supporting the use of nodal ratios in breast cancer prognosis. A thorough and methodological evaluation of the potential prognostic importance of nodal ratios in large multicenter data sets is merited and is currently being undertaken by the International Nodal Ratio Working Group.

The authors have declared no competing interests.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				V. Vinh-Hung, H. M. Verkooijen, G. Fioretta, G. Vlastos, E. Rapiti, and C. Bouchardy Reply to V. Van Belle et al J. Clin. Oncol., October 20, 2009; 27(30): e152 - e152. [Full Text] [PDF]

				V. Vinh-Hung, H. M. Verkooijen, G. Vlastos, G. Fioretta, I. Neyroud-Caspar, E. Rapiti, and C. Bouchardy Reply to K.M. Musallam et al J. Clin. Oncol., August 20, 2009; 27(24): e68 - e69. [Full Text] [PDF]

				V. Vinh-Hung, H. M. Verkooijen, G. Fioretta, I. Neyroud-Caspar, E. Rapiti, G. Vlastos, C. Deglise, M. Usel, J.-M. Lutz, and C. Bouchardy Lymph Node Ratio as an Alternative to pN Staging in Node-Positive Breast Cancer J. Clin. Oncol., March 1, 2009; 27(7): 1062 - 1068. [Abstract] [Full Text] [PDF]

				N. S. Russell, I. H. Kunkler, G. van Tienhoven, P. A. Canney, J. Thomas, J. Bartlett, M. J. van de Vijver, Y. Belkacemi, J. R. Yarnold, and P. J. Barrett-Lee Postmastectomy Radiotherapy: Will the Selective Use of Postmastectomy Radiotherapy Study End the Debate? J. Clin. Oncol., February 20, 2009; 27(6): 996 - 997. [Full Text] [PDF]

				R. Ricciardi and N. N. Baxter Association Versus Causation Versus Quality Improvement: Setting Benchmarks for Lymph Node Evaluation in Colon Cancer J Natl Cancer Inst, March 21, 2007; 99(6): 414 - 415. [Full Text] [PDF]