Prognostic value of nodal ratios in node-positive breast cancer: a compiled update

Author:

Vinh-Hung Vincent1,Nguyen Nam P2,Cserni Gábor3,Truong Pauline4,Woodward Wendy5,Verkooijen Helena M6,Promish Donald7,Ueno Naoto T8,Tai Patricia9,Nieto Yago10,Joseph Sue11,Janni Wolfgang12,Vicini Frank13,Royce Melanie14,Storme Guy15,Wallace Anne-Marie16,Vlastos Georges17,Bouchardy Christine18,Hortobagyi Gabriel N19

Affiliation:

1. Geneva University Hospitals, Geneva, Switzerland

2. University of Arizona, AZ, USA

3. Bács-Kiskun County Hospital, Department of Pathology, Kecskemét, Hungary

4. British Columbia Cancer Agency, Vancouver Island Centre, Department of Radiation Oncology, 2410 Lee Avenue, Victoria, BC, V8R6V5, Canada.

5. The University of Texas MD Anderson Cancer Center, Department of Radiation Oncology, TX, USA

6. Department of Epidemiology and Public Health, National University of Singapore, Singapore

7. Decision Analyst, VT, USA

8. Department of Breast Medical Oncology, Breast Cancer Translational Research Laboratory, Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, TX, USA

9. Allan Blair Cancer Center, Saskatchewan, Canada

10. Department of Stem Cell Transplantation and Cellular Therapy, UT MD Anderson Cancer Center, TX, USA

11. University of Northern Iowa, IA, USA

12. Frauenklinik, Klinikum der Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany

13. Beaumont Cancer Institute, Oncology Services Administration, MI, USA

14. UNM Cancer Research and Treatment Center, NM, USA

15. Oncologic Center UZ Brussel, Department of Radiation Oncology, Brussels, Belgium

16. UNM Cancer Research and Treatment Center, University of New Mexico, NM, USA

17. Geneva University Hospitals, Department of Gynecology and Obstetrics, Division of Gynecology, Senology and Surgical Gynecologic Oncology Unit, Geneva, Switzerland

18. Geneva Cancer Registry, Geneva, Switzerland

19. The University of Texas MD Anderson Cancer Center, Department of Medical Oncology, TX, USA

Abstract

The number of positive axillary nodes is a strong prognostic factor in breast cancer, but is affected by variability in nodal staging technique yielding varying numbers of excised nodes. The nodal ratio of positive to excised nodes is an alternative that could address this variability. Our 2006 review found that the nodal ratio consistently outperformed the number of positive nodes, providing strong arguments for the use of nodal ratios in breast cancer staging and management. New evidence has continued to accrue confirming the prognostic significance of nodal ratios in various worldwide population settings. This review provides an updated summary of available data, and discusses the potential application of the nodal ratio to breast cancer staging and prognostication, its role in the context of modern surgical techniques such as sentinel node biopsy, and its potential correlations with new biologic markers such as circulating tumor cells and breast cancer stem cells.

Publisher

Future Medicine Ltd

Subject

Cancer Research,Oncology,General Medicine

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