The appropriate number of ELNs for lymph node negative breast cancer patients underwent MRM: a population-based study
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Huiying Chi1, Chenyue Zhang2, Haiyong Wang3 and Zhehai Wang3
1Shanghai Geriatrics Institute of Traditional Chinese Medicine, Shanghai 200032, China
2Department of Integrative Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China
3Department of internal Medicine-Oncology, Shandong Cancer Hospital and Institute, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan 250117, China
Haiyong Wang, email: firstname.lastname@example.org
Zhehai Wang, email: email@example.com
Keywords: breast cancer, mastectomy, ELNs, lymph nodal negative, X-tile
Abbreviations: ELNs: examed lymph nodes, PLNs: positive lymph nodes, CSS: cancer specific survival, SEER: surveillance epidemiology and end results, NLNs: negative lymph nodes
Received: May 27, 2017 Accepted: July 25, 2017 Published: August 07, 2017
Whether number of examed lymph nodes (ELNs) would bring survival benefit for patients with negative lymph nodes after modified radical mastectomy (MRM) is uncertain. In our study, using the Surveillance Epidemiology and End Results (SEER) database between 2004 and 2009, we screened the appropriate patients with negative lymph nodes underwent MRM. The Cox proportional hazard analysis was used to determine the effect of number of ELNs on cancer specific survival (CSS). The results showed that the number of ELNs was not an independent prognostic factor on CSS (P = 0.940). Then the X-tile mode was used to determine the appropriate threshold for ELNs count. The results showed that 9 was the appropriate cut-off point. Next, the log-rank χ2 test was used to analyze the CSS based on different subgroup variables. The results showed that some subgroup variables including age < 50/ ≥ 50, grade I/III, AJCC T1/T2, ER positive/negative and PR positive/negative ,demonstrated significant CSS benefits among the patients with the number of ELNs ≤ 9 (all, P < 0.05). However, three subgroup variables including grade II, AJCC T3 and AJCC T4, the patients with the number of ELNs ≤ 9 did not bring significant CSS benefits (all, P > 0.1). In conclusion, our study demonstrated that the number of ELNs was not an independent prognostic factor on CSS, and 9 can be selected as the appropriate cut-off point of ELNs for patients with negative lymph nodes who underwent MRM.
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