Residual axillary disease after neoadjuvant chemotherapy (NACT) challenges prognostication with conventional pathologic nodal (ypN) staging, as post-therapy fibrosis and reduced nodal yield can lead to understaging in ypN-positive patients. We aimed to compare the prognostic performance of the metastatic lymph node ratio (mLNR) and the log odds of positive nodes (LODDS) with ypN stage in a homogeneous post-NACT ypN-positive breast cancer cohort, representing, to our knowledge, the first Turkish series to directly contrast these ratio-based metrics in this setting. We compared the prognostic value of the metastatic lymph node ratio (mLNR) and the log odds of positive nodes (LODDS) versus ypN stage in ypN positive breast cancer. We retrospectively analyzed 276 stage IIB–III patients (2010–2022) with residual nodal metastasis after NACT and surgery. Survival was evaluated with Kaplan–Meier and Cox models. Discrimination was summarized by AUC (ROC) with 95% CIs; pairwise DeLong tests compared mLNR versus LODDS. Primary analyses treated mLNR/LODDS as continuous variables; cutoff-based sensitivity analyses used 23.7% and − 1.24, respectively. Median follow-up among survivors was 127.7 months. Median dissected nodes were 17 (IQR 13–22); median positive nodes were 3. High LODDS ( > − 1.24 vs. ≤ − 1.24) independently associated with shorter DFS (HR 1.69, 95% CI 1.10–2.63; p = 0.017). mLNR and LODDS showed similar, moderate discrimination for OS and DFS; time-dependent AUCs were 0.605 (LODDS) and 0.596 (mLNR) for DFS and 0.618 (LODDS) and 0.620 (mLNR) for OS, with no significant differences by DeLong testing. Classical adverse features (residual breast tumor, triple-negative subtype, grade III) remained independently prognostic. In ypN-positive disease after NACT, mLNR and LODDS performed at least comparably to ypN stage, offering similar, moderate prognostic discrimination without clear superiority of one metric over the other. They may refine risk estimation as complementary nodal metrics, but subgroup signals are hypothesis-generating and require external validation before any impact on treatment decisions in routine practice; this long-term Turkish post-NACT cohort adds additional evidence to the emerging literature on ratio-based nodal metrics.
Güner et al. (Fri,) studied this question.