CLINICAL TRIAL Clinical significance of axillary nodal ratio in stage II/III breast cancer treated with neoadjuvant chemotherapy

modify the yield of involved axillary lymph nodes. The purpose of this study was to identify the clinical signifi-cance of the involved nodal ratios in patients with stage II/ III breast cancer treated with neoadjuvant chemotherapy. Methods Two hundred and five stage II and III breast cancer patients who received neoadjuvant docetaxel/ doxorubicin chemotherapy were enrolled in this prospec-tive study. The patients received three cycles of neoadjuvant chemotherapy followed by curative surgery, either breast-conserving surgery or mastectomy with axil-lary lymph node dissection, and received three additional cycles of docetaxel/doxorubicin chemotherapy as adjuvant. Adjuvant radiotherapy and hormonal therapy were given after adjuvant chemotherapy when indicated. Results The median follow-up duration was 28.9 months. The overall response rate (RR) for neoadjuvant chemotherapy was 77.6%. The mean nodal ratio was 0.29 (range, 0–1.0; nodal ratio B0.25, 121 [59.0%] vs. [0.25, 84 [41.0%]). Relapse free survival (RFS) of the patients who had a nodal ratio [0.25 was significantly shorter (Hazard Ratio (HR) = 2.701, P = 0.001). A nodal ratio[0.25 was also associated with a shorter overall survival (OS) (HR = 4.109, P = 0.006). However, RFS and OS were not different according to the absolute number of involved nodes (ANIN) (P = 0.166, P = 0.248, respectively). In multivariate analysis, the nodal ratio was an indepen-dent prognostic factor for RFS and OS (HR = 4.246, P \ 0.001; HR = 7.764, P \ 0.001). Conclusion Axillary nodal ratios have an independent prognostic value in stage II/III breast cancer treated with neoadjuvant chemotherapy. Nodal ratio might be a useful tool to identify the patients at high risk of relapse in the neoadjuvant setting