Nasopharynx: Clinical, pathologic, and radiologic assessment

Background: Lymph node metastasis is known as one of the strongest prognostic factors in breast cancer. The invasion mechanism of metastasized cancer cells in such immune cell-rich organs remains clear. Here, we aimed to elucidate the impact of metastasized cancer cells on the lymph node immune cell landscape. Methods: Multiscale transcriptomic analyses were performed on both metastatic and nonmetastatic lymph node samples from breast cancer patients with lymph node metastasis. As cancer cells interact with lymphocytes in lymph nodes in direct, proximal, and distant manners, we tried to capture the direct and proximal impact on immune cells in invaded lymph nodes by comparing paired metastatic and non-metastatic lymph node samples. Laser-micro-dissected sections were obtained from 17 lymph nodes across six breast cancer patients at stages II‒III, with each patient contributing both types of lymph nodes for direct comparison. We performed bulk transcriptome, spatial transcriptome, and imaging mass cytometry to analyze the obtained lymph nodes. Furthermore, we conducted immunohistochemistry analyses against a larger patient cohort (574 lymph nodes from 58 patients). Results: Comparing the transcriptomes of paired lymph nodes with and without metastasis from the same patients revealed selective downregulation of CD169+ macrophage-related genes in metastatic lymph nodes. The spatial transcriptome indicated a potential depletion of CD169+macrophages, initiators of anticancer immunity, from their residence in metastatic lymph nodes, while other principal immune cell types were unaltered. Mass cytometry imaging revealed that the numbers of CD169+ macrophages were smaller in the metastatic lymph nodes than in the nonmetastatic lymph nodes. Conversely, the number of B cells, CD4+ T cells, CD8+T cells, Treg cells, and CD11c+ cells remained comparable in both lymph node types. Additional immunohistochemistry analysis of 315 nonmetastatic lymph nodes and 159 metastatic lymph nodes from 58 patients with breast cancer showed that a reduced CD169+ macrophage population was prevalent in all breast cancer subtypes. CD169+ macrophages gradually decreased in correlation with pathological lymph node metastasis status, while no correlation was identified with pathological tumor size classification or metastasized cancer volume in invaded lymph nodes. Discussion: CD169+ macrophages are a unique type of resident macrophages in the lymphoid organs that present cancer-derived antigens to CD8+ T cells. The antigen-presenting role of CD169+ macrophages to T cells is a pivotal step in adaptive immunity. The elimination of CD169+ macrophage implies the disruption of the first step of the initial immune response. This study uncovered CD169+ macrophage suppression as a pronounced pathological phenotype in lymph nodes with breast cancer metastasis, thereby establishing it as a critical future therapeutic target. Citation Format: Yurina Maeshima, Tatsuki R. Kataoka, Alexis Vandenbon, Masahiro Hirata, Yasuhide Takeuchi, Yutaka Suzuki, Yukiko Fukui, Yumiko Ibi, Hironori Haga, Satoshi Morita, Masakazu Toi, Shinpei Kawaoka, Kosuke Kawaguchi. Selective elimination of CD169+ macrophages in lymph nodes invaded by breast cancers [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 106.

Lymph nodes (LN) metastasis differentiation from computed tomography (CT) images is a challenging problem. This study aims to investigate the association between radiomics image parameters and LN metastasis in colorectal mucinous adenocarcinoma (MAC).Clinical records and CT images of 15 patients were included in this study. Among them, 1 patient was confirmed with all metastatic LNs, the other 14 were confirmed with all non-metastatic LNs. The regions of the LNs were manually labeled on each slice by experienced radiologists. A total of 1054 LN regions were obtained. Among them, 164 were from metastatic LNs. One hundred nine image parameters were computed and analyzed using 2-sample t test method and logistic regression classifier.Based on 2 sample t test, image parameters between the metastatic group and the non-metastatic group were compared. A total of 73 parameters were found to be significant (P < .01). The selected shape parameters demonstrate that non-metastatic LNs tend to have smaller sizes and more circle-like shapes than metastatic LNs, which validates the common agreement of LN diagnosis using computational method. Besides, several high order parameters were selected as well, which indicates that the textures vary between non-metastatic LNs and metastatic LNs. The selected parameters of significance were further used to train logistic regression classifier with L1 penalty. Based on receiver operating characteristic (ROC) analysis, large area under curve (AUC) values were achieved over 5-fold cross validation (0.88 ± 0.06). Moreover, high accuracy, specificity, and sensitivity values were observed as well.The results of the study demonstrate that some quantitative image parameters are of significance in differentiating LN metastasis. Logistic regression classifiers showed that the parameters are with predictive values in LN metastasis, which may be used to assist preoperative diagnosis.

Background : Autophagy is believed to be important in tumorigenesis and tumor progression. The human beclin-1 gene, a key regulator of autophagy formation, located on chromosome 17q21, has been identified as the mammalian orthologue of Atg6 (autophagy-related gene) and may be a haploinsufficient tumor suppressor gene. Loss of expression or point mutation could serve as a mechanism of loss of beclin-1 tumor suppressor function in cancers. However, our recent study revealed that point mutation of the beclin-1 gene is a rare event in papillary thyroid carcinoma (PTC). Methods : We investigated the expression of beclin-1 in human PTC. Tissue samples from 86 cases of papillary thyroid carcinoma were used for the present study. 57 cases of papillary thyroid carcinoma were with lymph node metastasis. The expression of beclin-1 in tumor, normal tissue adjacent to tumor, distant normal tissue, metastatic lymph node and normal lymph node was examined with immunohistochemistry. The beclin-1 expression between tumor and normal tissue, metastatic and normal lymph node was also analyzed. Results : The expression of beclin-1 was detected in 88.4% (76/86) of the tumors and 98.2% (56/57) of metastatic lymph nodes. In contrast, normal tissues adjacent to tumor, distant normal tissues and normal lymph nodes showed no or very weak expression of beclin-1. Beclin-1 was significantly correlated with tumorigenesis and lymph node metastasis in human PTC. Conclusions : High expression of beclin-1 in PTC and metastatic lymph node suggest that neo-expression of beclin-1 may play a role in tumorigenesis and lymph node metastasis in human PTC.

Lymph node metastasis (LNM) occurs in less than 5% of soft tissue sarcoma (STS) patients and indicates an aggressive course of disease. Suspicious lymph nodes (LN) in staging imaging are a frequent topic of discussion in multidisciplinary tumor boards. Predictive markers are needed to facilitate stratification and improve treatment of STS patients. In this study, 56 STS patients with radiologically suspicious and subsequently histologically examined LN were reviewed. Patients with benign (n = 26) and metastatic (n = 30) LN were analyzed with regard to clinical, laboratory and imaging parameters. Patients with LNM exhibited significantly larger short axis diameter (SAD) and long axis diameter (LAD) vs. patients with benign LN (median 22.5 vs. 14 mm, p < 0.001 and median 29.5 vs. 21 mm, p = 0.003, respectively). Furthermore, the presence of central necrosis and high maximal standardized uptake value (SUVmax) in FDG-PET-CT scans were significantly associated with LNM (60 vs. 11.5% of patients, p < 0.001 and median 8.59 vs. 3.96, p = 0.013, respectively). With systemic therapy, a slight median size regression over time was observed in both metastatic and benign LN. Serum LDH and CRP levels were significantly higher in patients with LNM (median 247 vs. 187.5U/L, p = 0.005 and 1.5 vs. 0.55 mg/dL, p = 0.039, respectively). This study shows significant associations between LNM and imaging features as well as laboratory parameters of STS patients. The largest SAD, SUVmax in FDG-PET-CT scan, the presence of central necrosis, and high serum LDH level are the most important parameters to distinguish benign from metastatic LNs.

The patient was a 66-year-old man who had a advanced esophageal cancer with extended lymph node metastasis from the neck to mediastinum, especialy around the trachea. It was judged that radical operation was impossible, and chemotherapy by three cycles was started. Anticancer agents were selected according to the chemosensitivity tests using the MTTA assay of collected lymph node specimen from the neck. CDDP, 5-FU, and Etoposide were administered for the first two cycles, and Etoposide was switched to Leucovorin at the 3rd cycle. After chemotherapy, the primary lesion and lymph node metastasis were reduced to 62-78% in volume and subsequently a radical operation was performed. Histopathologically, the primary tumor almost disappeared with only a small cancer foci in three lesions. The histologic criteria on metastatic lymph nodes were moderately effective. In some patients with esophageal cancer judged to be unresectable, a radical operation can be expected to perform after effective chemotherapy.

Objective To investigate the patterns of lymph node metastases from nasopharyngeal carcinoma (NPC) based on magnetic resonance imaging (MRI) and to provide a basis for neck irradiation field in intensity-modulated radiation therapy.Methods From 2010 to 2013,3 100 patients newly diagnosed with NPC who underwent MRI were analyzed.All images were evaluated by the multi-disciplinary treatment group for NPC to analyze lymph node metastases.The locations of lymph nodes were determined by the RTOG consensus guidelines published in 2003.Results Of 3100 patients,2 679 (86.42％) had lymph node metastases; the detailed distribution was as follows:lateral retropharyngeal region (2012 patients,64.90％ ;6 patients were also in the medial group),level Ⅱ b(2341 patients,75.52％ ;492 had the upper border reaching half of C1 vertebra and 115 had the upper border reaching the skull base),level Ⅱ a(1798 patients,58.00％),level Ⅲ (1 184 patients,38.19％),level Ⅳ (350 patients,11.29％ ;28 had the lower border beyond the RTOG recommended boundary),level Ⅴ (995 patients,32.10％ ;91 had the lymph nodes beyond the RTOG recommended boundary),level Ⅰ b (115 patients,3.71％),and parotid region (40 patients,1.29％).Extensive ipsilateral lymph node metastases were seen in patients with lymph nodes metastases in levels Ⅳ and Ⅴ,and the total numbers of involved nodes were ≥ 6 and 7.Skip metastasis occurred in 6 patients (0.19％).Conclusions Metastases to retropharyngeal lymph nodes are seen mainly in the lateral group but rarely in the medial group.The upper border of level Ⅱ lymph nodes should be the skull base.Lymph node metastases from NPC are in an orderly manner,and skip metastasis is rarely seen.When level Ⅳ/Ⅴ lymph nodes are involved,there might exist metastases beyond the RTOG recommended boundary.In case of extensive ipsilateral lymph node metastases,the parotid region might be involved. Key words: Nasopharyngeal carcinoma; Magnetic resonance imaging; Lymph node metastasis; Lymph node subregion

Objective To study the characteristics and the impact of lymph node metastasis on radical resection for pancreatic head cancer to provide a theoretical basis for lymphadenectomy in radical resection.To study the reliability of using a surgical microscope to detect lymph nodes in radically resected specimens of pancreatic head cancer.Methods Lymph nodes in the specimens after radical pancreaticoduodeneetomy (pancreaticoduodenectomy + D2 regional lymphadenectomy) were identified using a surgical microscope and they were grouped using the JPS standard.The position and the frequency of the lymph nodes retrieved,and their association with other clinicopathologic factors were analysed.The results were compared with the data published in 2004 on 46 patients to evaluate the reliability of using a surgical microscope.Results Lymph node metastasis was detected histopathologically in 101 patients (67.3％).The median number of lymph nodes retrieved in the specimens as detected using the surgical microscope was 38.2.The most commonly involved lymph node groups were No.13 (64.5％),No.14 (51.7％),No.17 (38.6％),No.12 (25.8％),No.16 (20.8％).Lymph node metastasis was significantly associated with tumour T stage,tumour invasion and differentiation,preoperative serum level of CA19-9 and CA72-4,but not with patient age,sex,or tumour location.There were no significant differences between the results and the data of the previous study in 2004.Conclusions Extended lymphadenectomy is necessary because extensive lymph node metastasis was common.Surgical microscopy is an effective and reliable method to detect lymph nodes in resected specimens of pancreatic head cancer for accurate pathologic staging. Key words: Pancreatic neoplasms; Pancreaticoduodenectomy; Lymphatic metastasis; Surgical microscope

Differentiated thyroid cancers (DTCs) which include papillary thyroid cancer and follicular thyroid cancer have a predilection for lymph nodal metastasis. The incidence of lymph node (LN) metastasis in DTC has been reported to be between 20% and 50% at presentation and 5% and 20% during surveillance in the follow-up period. Surgery is the mainstay of treatment in these cancers. Fine-needle aspiration cytology (FNAC) has been the gold standard for diagnosis at presentation as well as during post-treatment cancer surveillance. However, inadequate tissue sample necessitates additional needle passes, which may add additional costs and inconvenience to the patient. Studies have shown that the measurement of thyroglobulin (Tg) levels in the FNA fluid improves the diagnostic results of the FNAC. American Thyroid Association (ATA) recommends that during follow-up, if a positive diagnosis would change the management, LNs which are suspicious on the ultrasound with >8–10 mm diameter should undergo FNAC with Tg washout (strong recommendation, low-quality evidence).1 We discuss the role of Tg washout in the DTC management algorithm. With the results from a systematic review and meta-analysis Xu et al.,2 supported the role of FNAC and FNA-Tg as an excellent tool for diagnosis of LN metastasis. A total of 2786 samples of suspicious LNs were analyzed. The authors reported the diagnostic value of the combination of FNAC with FNA-Tg was better than FNAC alone. (relative odds ratio 16.01, P = .001, 95% confidence interval [CI] 4.61–55.60). The authors concluded that patients with suspicious LN metastasis in DTC should be recommended to have the combination of FNAC and FNA-Tg for diagnosis. This study, however, did not comment on the ideal cutoff value of the FNA-Tg as it was not designed to answer the question. Moon et al.3 also reported that FNA-Tg and FNAC had a higher diagnostic power when using FNA-Tg or FNAC alone (sensitivity, 98.4%; specificity, 94.4%) in a retrospective study of 528 samples. The median FNA-Tg in malignant and benign LNs was 521.2 (3676.8) ng/mL and 0.1 (0.2) ng/mL, respectively. The cutoff value for Tg washout for LNs to be considered malignant was determined as 1 ng/mL (area under the curve [AUC] was 0.967 [95% CI, 0.949–0.984]). This cutoff value did not change in LNs that were followed up for a longer duration. Interestingly, anti-Tg antibodies (TgAb) did not correlate with FNA-Tg cutoff values (P = .161) in this study. Duval et al.4 evaluated the accuracy of FNA-Tg measurement to detect DTC metastases and the influence of thyroid status and anti-Tg antibodies (TgAb). They performed ultrasound-guided FNA for cytological examination and FNA-Tg measurement in 119 patients and calculated accuracy by comparing FNA-Tg results to histologic reports or 1 year follow-up with ultrasound and Tg levels. The median value for FNA-Tg in patients with metastatic LN was 3263.0 ng/mL (838.55–12,507.50) compared to median levels of 0.2 ng/mL (0.2–0.2) in patients without LN metastasis. They recommended a cutoff value of 4.41 ng/mL with sensitivity of 98% and specificity of 96%. Patients with metastatic LNs on levothyroxine withdrawal had higher FNA-Tg values compared to patients with suppressed thyroid-stimulating hormone (TSH). However, FNA-Tg did not significantly correlate with levothyroxine dosage or TSH suppression level. The interference of TgAb with serum Tg is a technical problem that limits its use as a tumor marker in patients with positive TgAb. However, patients with metastatic LNs had similar median FNA-Tg levels regardless of TgAb. Further, the values of Tg in patients with and without thyroid antibodies were 88.8 and 3,263 ng/mL, respectively; P = .57. The ATA in their 2015 guidelines recommend a Tg level of 1 ng/mL as cutoff value for Tg levels in post-total thyroidectomy patients.1 Kahramangil et al.5 compared different models to interpret the levels of Tg in the washout sample. The authors calculated the test accuracies across Tg washout cutoff value at 1 ng/mL, Tg washout at 2.5 ng/mL, Tg washout/Tg ratio 0.1 and absolute Tg value. Using the cutoff value of Tg washout at 1 ng/mL the sensitivity, specificity, positive predictive value, negative predictive value (NPV), and accuracy were 94%, 96%, 98%, 90%, and 95%, respectively. When the Tg washout cutoff value of 2.5 ng/mL was used, the NPV and specificity were higher at 100% and 100%, respectively. The literature supports the use of Tg washout as an adjunct to FNAC as it improves its diagnostic accuracy. The commonly used cutoff value of Tg is 1 ng/mL according to the ATA guidelines. Tg washout is particularly helpful in cancer surveillance during the follow-up period especially in suspicious LNs with lower tissue yield or cytologic and discordant ultrasound findings. However, for LNs with highly suspicious ultrasound features of malignancy, FNAC alone suffices for the diagnosis.

Evidence for the changes of antitumor immune response during lymph node metastasis in head and neck squamous cell carcinoma

To determine the usefulness of q-space MR imaging as means of evaluating the depth of mural invasion, the histologic grades, and lymph node metastasis in esophageal carcinomas. Twenty esophageal specimens each containing a carcinoma were studied with a 7.0 Tesla MR imaging system. q-Space MR images were obtained with a 50-60 mm × 25-30 mm field of view, 256 × 128 matrix, 2 mm section thickness, 10 b values ranging from 0 to 7163 s/mm(2) , and a motion-probing gradient in the y-direction, and the MR images were compared with the histopathologic findings. The mean displacement maps, probability for zero displacement maps, and kurtosis maps in all 20 carcinomas (100%) made it possible to identify the depth of tumor invasion of the esophageal wall. These q-space MR imaging parameters were significantly correlated with the histologic grades of the esophageal carcinomas (P < 0.01), and also significantly correlated with their nuclear-cytoplasmic ratios (P < 0.01 or P < 0.001) and tumor cellularity (cell density) (P < 0.01 or P < 0.001). The q-space MR imaging parameters were also capable of differentiating between the metastatic lymph nodes and nonmetastatic lymph nodes (P < 0.01). q-Space MR imaging ex vivo provides excellent diagnostic accuracy for evaluating mural invasion by esophageal carcinomas, the histologic grades of esophageal carcinomas, and lymph node metastasis by esophageal carcinomas.

The macrofollicular variant of papillary thyroid carcinoma is a rare subtype of the follicular variant of papillary thyroid carcinoma and is usually characterized by an indolent clinical course. The tumors are prone to be misdiagnosed as benign due to their macrofollicular architecture and bland cytologic features. We report a rare case of the macrofollicular variant of papillary thyroid carcinoma with extensive lymph node metastases. The patient was a 48-year-old female with a right thyroid nodule and multiple enlarged lymph nodes in the right neck. It was not possible to make a definitive diagnosis of malignancy on fine-needle aspiration cytology and intraoperative frozen section. She underwent total thyroidectomy with right modified radical neck dissection. The surgical specimen showed a 2.5 × 1.5 × 10 cm, well-circumscribed macrofollicular variant of papillary thyroid carcinoma in the right lobe and multiple central and right lateral neck lymph node metastases. Molecular testing for BRAF, NRAS, HRAS, and KRAS was all negative. We then reviewed the demographic and clinicopathologic characteristics of 71 patients with the macrofollicular variant of papillary thyroid carcinoma. The cytologic or histopathologic diagnosis of macrofollicular variant of papillary thyroid carcinoma can be difficult. Extensive lymph node metastases caused by the macrofollicular variant of papillary thyroid carcinoma may occur even in the absence of capsular or lymphovascular invasion. This review will help to better understand the nature of the macrofollicular variant of papillary thyroid carcinoma.

Detection of Pelvic Lymph Node Metastases in Patients With Clinically Localized Prostate Cancer: Comparison of [ 18F]Fluorocholine Positron Emission Tomography-Computerized Tomography and Laparoscopic Radioisotope Guided Sentinel Lymph Node Dissection

The objective of the study was to evaluate the incidence of level IIb lymph node metastases in neck dissections for thyroid papillary carcinoma (TPC) patients. 47 neck dissections of 33 patients with TPC were prospectively evaluated. Selective neck dissections (levels II, III, IV, and V) were performed in all cases. If level I lymph node metastasis was suspected during the procedure, level I dissection was also performed. All level IIb specimens were sent separately from the remainder of the neck dissection for the pathological examination. The number of dissected and metastatic lymph nodes in each specimen was recorded. Twenty-two of 47 neck dissections (46.8%) were positive for the lymph node metastasis. Among 47 neck dissection specimens, the incidence of lymph node metastasis at level II was 12.7% (6 of 47) and level IIb was 2.1% (1 of 47). The rate of level IIb lymph node involvement among patients with metastatic cervical lymph nodes was 4.5% (1 of 22). The specimen with metastatic lymph node at level IIb had also metastasis at levels IIa, III, IV, and V. The results of the present study suggested that lymph node metastases in level IIb are rare in patients with TPC undergoing neck dissection.

To investigate the role of cancer stem cells (CSCs) in lymph node metastasis (LNM) of oral squamous cell carcinoma (OSCC), focusing on the expression and biological significance of nuclear receptor subfamily 2 group F member 2 (NR2F2). Single-cell RNA sequencing data from OSCC patients were analyzed using the CytoTRACE algorithm to assess stemness. Gene set scores were calculated with the irGSEA and GSVA R packages. GO and KEGG analyses identified enriched pathways. NR2F2 and CD44 expression in OSCC and lymph nodes (LNs) were validated via immunohistochemistry and immunofluorescence. NR2F2/Nr2f2 overexpression and knockdown cell lines were established, with stemness markers confirmed by Western blot. Functional assays evaluated stemness, proliferation, migration, and invasion capabilities of OSCC cells. In vivo experiments evaluated the ability of NR2F2 to promote tumor growth and metastasis. Bulk RNA sequencing and drug sensitivity analyses explored NR2F2-related mechanisms and drug responses. CSCs in OSCC were divided into five subgroups, with NR2F2 identified as the key gene in CSC4, the subgroup with the highest stemness, and found to be overexpressed in metastatic LNs. Immunohistochemistry showed NR2F2 overexpression in OSCC, associated with LNM. Immunofluorescence confirmed co-expression of NR2F2 and CD44 in metastatic OSCC and LNs. Overexpression of NR2F2 enhanced stemness, proliferation, and migration of OSCC cells. In vivo experiments showed that NR2F2 promoted the growth and LNM of OSCC. Bulk RNA sequencing revealed that NR2F2 is involved in multiple pathways and plays a role in LNM. Trametinib was identified as a sensitive drug. NR2F2 is associated with the maintenance of tumor stemness and may influence LNM in OSCC by promoting tumor cell proliferation and migration.

Background: Metastatic regional lymph nodes (LN) is a strong predictor of worse long-term outcome after resection of breast cancer. This study aimed to compare the prognostic performance of American Joint Committee on Cancer (AJCC) N stage relative to lymph node ratio (LNR), log odds of metastatic lymph nodes (LODDS), number of removed lymph nodes (NRLNs), and number of negative lymph nodes (NNLNs) in breast cancer patients. Methods: All of the breast cancer patients who underwent surgery between 2004 and 2012 were identified from the Surveillance, Epidemiology, and End Results database. Restricted cubic spline functions were used to characterize the association between continuous variables and the risk of death and determine the optimal cut-off points. The Cox proportional hazards models were constructed, and the relative discriminative abilities of the different LN staging systems were assessed using the Akaike's Information Criterion (AIC) and the Harrell's concordance index (C-index). Results: A total of 264,096 breast cancer patients were enrolled, and 177,598 (67.2%) had no lymph node metastasis, whereas 86,498 (32.8%) had lymph node metastasis. 187,785 (71.1%) patients had a limited number of LNs harvested (NRLN &amp;lt;10). The median follow-up time was 73 months, and the 8-year overall survival (OS) and breast cancer-specific survival (BCSS) were 82.6% and 90.4%, respectively. LNR, LODDS, NRLNs, and NNLNs were all nonlinearly associated with OS and BCSS. Patients with metastatic LN had an increased risk of OS (hazards ratio: 2.32, 95% confidence interval: 2.27–2.37; P &amp;lt; 0.001) and BCSS (hazards ratio: 4.53, 95% confidence interval: 4.40–4.66; P &amp;lt; 0.001). When LNR was equal to 0 or 1, there was a heterogeneity of outcomes, and LODDS still yielded informative values compared to LNR. Among the entire cohort, LNR modeled as a continuous variable had a somewhat better prognostic performance (AIC: 923231.4 and C-index: 0.722 for OS; AIC: 482962.3 and C-index: 0.817 for BCSS) than any of other LN staging systems. However, a model with AJCC N stage showed the best fit in patients with a limited number of LNs harvested (AIC: 501321.8 and C-index: 0.699 for OS; AIC: 212605.6 and C-index: 0.809 for BCSS). When assessed among patients with metastatic LN, LODDS outperformed other staging systems including AJCC N stage, LNR, NRLNs and NNLNs, whenever assessed using continuous (AIC: 428626.2 and C index: 0.728 for OS; AIC: 296886.8 and C index: 0.770 for BCSS) or categorical (AIC: 429527.5 and C index: 0.722 for OS; AIC: 297796.6 and C index: 0.762 for BCSS) cutoff values. Conclusions: Although LNR assessed as a continuous variable was the most potent method to stratify patients regardless of LN status, the prognostic superiority of LNR is confounded by a limited LN harvest. LODDS was a better and more powerful predictor of survival when patients were LN positive, especially among those patients with either very low or high LNR. Citation Format: Gong Y, Ji P, Jiang Y-Z, Hu X, Shao Z-M. Comparing prognostic performance of different lymph node staging systems among patients with breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-08-36.