CLINICAL TRIAL Clinical significance of axillary nodal ratio in stage II/III breast cancer treated with neoadjuvant chemotherapy Bhumsuk Keam Seock-Ah Im Hee-Jun Kim Do-Youn Oh Jee Hyun Kim Se-Hoon Lee Eui Kyu Chie Wonshik Han Dong-Wan Kim Nariya Cho Woo Kyung Moon Tae-You Kim In Ae Park Dong-Young Noh Dae Seog Heo Sung Whan Ha Yung-Jue Bang Received: 12 May 2008 / Accepted: 6 August 2008 Ó Springer Science+Business Media, LLC. 2008 Abstract Purpose Neoadjuvant chemotherapy may 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. Keywords Nodal ratio Á Neoadjuvant chemotherapy Á Prognosis Á Breast cancer Á Nodal stage Introduction With respect to breast cancer patients, neoadjuvant che- motherapy has several significant proven and theoretical advantages. Neoadjuvant chemotherapy can convert inop- erable disease to operable disease and can increase the rate of breast-conserving surgery [1–3]. However, the loss of B. Keam Á S.-A. Im (&) Á H.-J. Kim Á D.-Y. Oh Á J. H. Kim Á S.-H. Lee Á D.-W. Kim Á T.-Y. Kim Á D. S. Heo Á Y.-J. Bang Department of Internal Medicine, Seoul National University College of Medicine, 28 Yongon-Dong, Chongno-Gu, Seoul 110-744, Republic of Korea e-mail: moisa@snu.ac.kr S.-A. Im Á D.-Y. Oh Á J. H. Kim Á S.-H. Lee Á E. K. Chie Á W. Han Á D.-W. Kim Á T.-Y. Kim Á I. A. Park Á D.-Y. Noh Á D. S. Heo Á S. W. Ha Á Y.-J. Bang Cancer Research Institute, Seoul National University College of Medicine, Seoul 110-799, Republic of Korea E. K. Chie Á S. W. Ha Department of Radiation Oncology, Seoul National University College of Medicine, Seoul 110-744, Republic of Korea W. Han Á D.-Y. Noh Department of Surgery, Seoul National University College of Medicine, Seoul 110-744, Republic of Korea N. Cho Á W. K. Moon Department of Radiology, Seoul National University College of Medicine, Seoul 110-744, Republic of Korea I. A. Park Department of Pathology, Seoul National University College of Medicine, Seoul 110-744, Republic of Korea 123 Breast Cancer Res Treat DOI 10.1007/s10549-008-0160-9