The prognostic role of lymph node ratio in breast cancer patients received neoadjuvant chemotherapy: A dose-response meta-analysis

Jinzhao Liu; Yifei Li; Weifang Zhang; Chenhui Yang; Chao Yang; Liang Chen; Mingjian Ding; Liang Zhang; Xiaojun Liu; Guozhong Cui; Yunjiang Liu

doi:10.3389/fsurg.2022.971030

The prognostic role of lymph node ratio in breast cancer patients received neoadjuvant chemotherapy: A dose-response meta-analysis

Front Surg. 2022 Oct 26:9:971030. doi: 10.3389/fsurg.2022.971030. eCollection 2022.

Authors

Jinzhao Liu¹, Yifei Li², Weifang Zhang³, Chenhui Yang³, Chao Yang³, Liang Chen¹, Mingjian Ding¹, Liang Zhang¹, Xiaojun Liu¹, Guozhong Cui¹, Yunjiang Liu^{3

4}

Affiliations

¹ The Second Department of Thyroid and Breast Surgery, Cangzhou Central Hospital, Cangzhou, China.
² Department of Pathology, Fourth Hospital of Hebei Medical University, Shijiazhuang, China.
³ Department of Breast Cancer Center, Fourth Hospital of Hebei Medical University, Shijiazhuang, China.
⁴ Hebei Provincial Key Laboratory of Tumor Microenvironment and Drug Resistance, Hebei Medical University, Shijiazhuang, China.

Abstract

Background: As neoadjuvant chemotherapy is widely used in breast cancer patients, the lymph node ratio has not been fully validated as a prognostic indicator of breast cancer received neoadjuvant chemotherapy. This study was conducted to investigate the prognostic value of lymph node ratio in breast cancer patients received neoadjuvant chemotherapy.

Methods: Systematic searches were performed in the PubMed, Embase, and Cochrane Library databases until 15 December 2021 for studies on the association between lymph node ratio and the prognosis of breast cancer after neoadjuvant chemotherapy. Overall survival and disease-free survival were used as outcome events, and hazard ratio was chosen as the parameter to evaluate the correlation. The dose-response relationship was assessed by restricted cubic splines. In the subgroup analyses, which were used to explore potential heterogeneity among the included studies according to study region and sample size. Sensitivity analysis was performed to assess the stability of individual studies, and publication bias was determined with funnel plots, Begg's test, and Egger's test. All statistical analyses were performed using Stata 15.1.

Results: A total of 12 studies with 4,864 patients were included in this meta-analysis. In this study, high lymph node ratio was significantly associated with decreased overall survival (HR: 4.74; 95%CI: 3.36-6.67; P < 0.001) and disease-free survival (HR: 4.77; 95%CI: 3.69-6.17; P < 0.001). Moreover, the dose-response meta-analysis showed a linear association between higher lymph node ratio and shorter overall survival and disease-free survival in breast cancer patients after neoadjuvant chemotherapy.

Conclusions: The meta-analysis suggested that high lymph node ratio was significantly associated with short overall survival and disease-free survival in breast cancer patients after neoadjuvant chemotherapy. Therefore, lymph node ratio is an independent predictive factor for the prognosis of breast cancer patients after neoadjuvant chemotherapy, which may better refine the cancer staging system.

Keywords: breast cancer; lymph node ratio; meta-analysis; neoadjuvant chemotherapy; prognosis.

Publication types

Review