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- W1969595867 abstract "We appreciate Van Belle et al’s valuable commenting report. Van Belle et al propose a different value for lymph node ratio (LNR) to estimate disease-free survival based on 686 patients with breast cancer with positive lymph nodes and a short follow-up. We previously demonstrated that in patients with breast cancer, even a 10-year follow-up may not be adequate to evaluate disease-free survival. Our study was based on 1,829 patients and a mean follow-up of 9 years extending up to 30 years. Yet, despite these caveats of small number of patients and short follow-up, Van Belle et al show that the LNR is a strong prognosticator with a hazard ratio for disease-free survival of 9.46. Furthermore, they show that the LNR supersedes the number of positive nodes, that categorization of the LNR causes minor loss of efficiency, and, elegantly using time-dependent receiver operating characteristic graphs, they show that the categorized LNR maintains its superiority over the pN classification. Van Belle et al propose 0.10 and 0.40 as the optimal pair of cutoffs for LNR classification, which disagrees with our LNR values of 0.20 and 0.65. Part of the explanation might be the different search procedures. We included a smoothing of the likelihood profiles before computing the minimal difference, whereas Van Belle et al did not. In summary, we are thankful to Van Belle et al for their commenting report which complements Woodward et al’s nodal ratio review with recent and homogeneous data, further establishing the importance of the LNR. However, the issue of optimal cutoffs remains open and will require a multi-institution study in order to reach a consensus." @default.
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- W1969595867 date "2009-10-20" @default.
- W1969595867 modified "2023-09-25" @default.
- W1969595867 title "Reply to V. Van Belle et al" @default.
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- W1969595867 doi "https://doi.org/10.1200/jco.2009.24.0937" @default.
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