Lymph Node Ratio (LNR) as a predictive factor in addition to pNstaging in Syrian-breast cancer patients at diagnosis

Background: Metastasis to the axillary lymph nodes is a key indicator of prognosis in breast cancer. Lymph node ratio (LNR) is reported to be superior to the absolute number of nodes involved (pN stage) in classifying patients at high versus low risk of death following breast cancer.Aim of the study: This prospective study investigated the predictive value of the lymph node ratio (LNR) compared with the number of positive lymph nodes (pN), serum C-reactive protein (CRP) levels, hormones status and other prognostic factors in Syrian -breast cancer patients.Patients and methods: 60 breast cancer patients aged between 32 to 77 years old, admitted in National hospital of Jableh (Lattakia-Syria) were selected from December 2015 until December 2016. LNR calculated as the ratio of the number of positive nodes to the total number of nodes excised, LNR had been categorized as low: (0 -0.2), intermediate: (>0.2 - 0.65), and high risk: (>0.65 - 1). Blood samples were collected for CRP levels on admission and measured by immunoturbidimetric determination, levels >5mg/l were considered positive. Estrogen-Receptor (ER), Progesterone Receptor (PR) and human epidermal growth factor receptor 2 (Her-2) expression were assessed.Results: Strong relationship was found between LNR-classification system and increased number of positive lymph nodes in breast cancer patients (P< 0.0001, r = 0.91). Patients with pN>4 were at high risk (100%) in comparison with patients with pN