Background To judge the prognostic value of axillary lymph node ratio (LNR) as compared to the number of involved nodes (pN stage) in patients with axillary lymph node-positive breast cancer treated with mastectomy without radiation. analysis showed that both LNR and pN stage were prognostic factors of LRFS and OS (p<0.05). Multivariate analysis indicated that LNR was an independent prognostic factor of LRFS and OS (p<0.05). pN stage had no significant Dabigatran effect on LRFS or OS (p>0.05). In subgroup analysis the LNR identified groups of patients with different survival rates based on pN stage. Conclusions LNR is superior to pN staging as a Dabigatran prognostic factor in lymph node-positive breast cancer after mastectomy and should be used as one of the indications for adjuvant radiation therapy. Keywords: Breast cancer Lymph node ratio Mastectomy Recurrences Radiotherapy Introduction Studies have shown that radiation therapy improves locoregional control of axillary lymph node-positive breast cancer and thereby benefits survival [1-3]. The positive lymph node status has been used as an indicator for adjuvant radiotherapy after mastectomy [4 5 However overall outcomes can be variable depending on the extent of axillary lymph node removal. Additionally the decision to perform radiation therapy is in part physician dependent. The lymph node ratio (LNR) is defined as the ratio of the number of positive axillary lymph nodes to the number of removed axillary lymph nodes and has attracted a great deal of attention. Veronesi et al. [6] has suggested that use of the LNR may minimize the difference between clinical judgment and the real status of the lymph nodes that arises due to differing physician practices. Currently studies on the LNR have been mainly focused on patients with 1-3 Dabigatran positive nodes [7 8 The reliability of the LNR in predicting the prognosis in patients with greater than 3 positive nodes has rarely been addressed. In this retrospectively study we likened the prognostic ideals from the LNR and amount of included nodes (pN) staging in 1068 individuals with axillary lymph node-positive breasts cancer without rays therapy after mastectomy to look for the value from the LNR as an sign for adjuvant rays therapy in these individuals. Materials and strategies Study population The analysis was performed relative to the Declaration of Helsinki and was authorized by the ethics committee of Sunlight Yat-Sen University Cancers Middle. Written consent was presented with from the individuals for their info to be kept in a healthcare facility database and useful for research. A complete of 1068 woman stage II-III breasts cancer individuals treated between January 1998 and could 2007 at sunlight Yat-sen University Cancers Center had been one of them research. All individuals had been identified as having unilateral breasts cancer without preliminary faraway metastasis and underwent mastectomy and axillary lymph node dissection. Staging was based on the 2009 2009 7th edition of the American Joint Committee on Cancer (AJCC) staging system and patients with a post-mastectomy pathological stage of T1-4N1-3M0 were included. In all cases the tumor was completely dissected and surgical margins were unfavorable. No neo-adjuvant therapy was administered before surgery and no adjuvant radiotherapy was provided after surgery. No patients had any serious comorbid conditions. Clinical and pathological factors and lymph node status Clinical and pathological characteristics were used to assess the risk of locoregional recurrence and death and included age menopausal status T stage pN stage and estrogen receptor (ER) progesterone receptor (PR) and human epithelial growth factor receptor family 2 Dabigatran (Her-2) status. T staging and pN staging were determined according to the AJCC staging system (7th edition 2009 LNR classifications were based on the report by Vinh-Hung et al. [9]. Patients were classified into 3 groups: LNR 0.01-0.20 LNR 0.21 – 0.65 and LNR > 0.65. Follow-up and survival endpoints Follow-up was scheduled every 3-6 months after surgery. Locoregional recurrence-free survival (LRFS) HDAC7 and overall survival (OS) were the primary Dabigatran study endpoints. Locoregional recurrence was defined as pathologically confirmed relapse around the chest wall supra- and infraclavicular fossa axillary area or internal mammary region. Mortality was defined as breast cancer-related death. Dabigatran Statistical analysis Data were analyzed using SPSS 16.0 software. Kaplan-Meier curves were generated to compare the survival rates. The statistical significance of data was analyzed by log-rank test. Cox stepwise regression analysis was used for multivariate analysis and.