{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,10]],"date-time":"2026-01-10T10:46:56Z","timestamp":1768042016070,"version":"3.49.0"},"reference-count":76,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2010,10,1]],"date-time":"2010-10-01T00:00:00Z","timestamp":1285891200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2010,10,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Learning Objectives<\/jats:title>\n                  <jats:p>After completing this course, the reader will be able to: Identify changes in medical\/surgical practice that can affect the prognostic performance of established prognostic factors such as lymph node involvement in breast cancer.Explain how the lymph node ratio can help to adjust against practice-related changes.Use the lymph node ratio as a measure of tumor burden in order to weigh the risk of breast cancer death against other causes of death in elderly patients.<\/jats:p>\n                  <jats:p>This article is available for continuing medical education credit at CME.TheOncologist.com<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Purpose.<\/jats:title>\n                  <jats:p>The purpose of this article was to examine the relationship between age and lymph node ratio (LNR, number of positive nodes divided by number of examined nodes), and to determine their effects on breast cancer (BC) and overall mortality.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods.<\/jats:title>\n                  <jats:p>Women aged \u226550 years, diagnosed in 1988\u20131997 with a unilateral histologically confirmed T1-T2 node positive surgically treated primary nonmetastatic BC, were selected from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER). Generalized Additive Models for Location Scale and Shape (GAMLSS) were used to evaluate the age-LNR relationship. Cumulative incidence functions and multivariate competing risks analysis based on model selection by the Bayesian Information Criterion (BIC) were used to examine the effect of age and LNR on mortality. Low LNR was defined as \u22640.20, mid-LNR 0.21\u20130.65, and high LNR &amp;gt;0.65.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results.<\/jats:title>\n                  <jats:p>GAMLSS showed a nonlinear LNR-age relationship, increasing from mean LNR 0.26\u20130.28 at age 50\u201370 years to 0.30 at 80 years and 0.40 at 90 years. Compared with a 9.8% [95% confidence interval (CI) 8.8%\u201310.8%] risk of BC death at 5 years in women aged 50\u201359 years with low LNR, the risk in women \u226580 years with low LNR was 12.6% [95% CI 10.1%\u201315.0%], mid-LNR 18.1% [13.9%\u201322.1%], high LNR 29.8% [22.7%\u201336.1%]. Five-years overall risk of death increased from 40.8% [37.5%\u201343.9%] by low LNR to 67.4% [61.4%\u201372.4%] by high LNR. The overall mortality hazard ratio for age \u226580 years with high LNR was 7.49 [6.54\u20138.59], as compared with women aged 50\u201359 years with low LNR.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion.<\/jats:title>\n                  <jats:p>High LNR combined with older age was associated with a threefold increased risk of BC death and a sevenfold increased hazard ratio of overall mortality.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1634\/theoncologist.2010-0044","type":"journal-article","created":{"date-parts":[[2010,10,8]],"date-time":"2010-10-08T02:53:22Z","timestamp":1286506402000},"page":"1050-1062","source":"Crossref","is-referenced-by-count":26,"title":["Age and Axillary Lymph Node Ratio in Postmenopausal Women with T1-T2 Node Positive Breast Cancer"],"prefix":"10.1093","volume":"15","author":[{"given":"Vincent","family":"Vinh-Hung","sequence":"first","affiliation":[{"name":"University Hospitals of Geneva, Geneva, Switzerland"},{"name":"Vrije Universiteit Brussel, Elsene, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sue A.","family":"Joseph","sequence":"additional","affiliation":[{"name":"University of Northern Iowa, Cedar Falls, Iowa, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nadege","family":"Coutty","sequence":"additional","affiliation":[{"name":"University Hospitals of Geneva, Geneva, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bevan Hong","family":"Ly","sequence":"additional","affiliation":[{"name":"John A Burns School of Medicine, University of Hawaii at Manoa, Honolulu, Hawaii, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Georges","family":"Vlastos","sequence":"additional","affiliation":[{"name":"University Hospitals of Geneva, Geneva, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nam 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