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Kuru et al [16]. reported that the number of involved lymph nodes, RLN count, NLN count, and LNR were prognostic factors of breast cancer patients with positive lymph nodes, and patients with a NLN count > 15 had a better prognosis. Karlsson et al [17]. also reported that NLN count was an independent prognostic factor in breast cancer patients, and a NLN count of �� 10 was associated with a better prognosis as compared to a NLN count of [http://en.wikipedia.org/wiki/MMP23B MMP23B] when axillary lymph nodes were negative [17]. In the current study, the number of NLNs had prognostic value not only in patients with positive lymph nodes, but also in those with negative lymph nodes. Previous studies have shown that the number of NLNs in breast cancer patients may represent a balance between host cells and cancer cells, and might influence the presence of circulating cancer cells [23]. In studies on colorectal cancer, the number of NLNs was related to the host immune response to cancer cells and the molecular biology of cancer cells [24,25]. This may be another mechanism underlying the influence of NLN count on the prognosis of breast cancer. Breast cancer patients with more positive axillary lymph nodes are more susceptible to disease failure, and those with more negative lymph nodes may further avoid recurrence and metastasis. This may explain why patients with a higher pN stage had a poorer prognosis, and patients with more NLNs had a better [http://www.selleckchem.com/products/abt-199.html find more] prognosis in this study. Studies have shown that axillary lymph node dissection may not affect the survival of breast cancer patients who receive [http://www.selleckchem.com/products/pci-32765.html Ibrutinib datasheet] breast-conserving therapy and have negative or 1-2 positive sentinel lymph nodes, on the basis of which investigators have proposed that axillary lymph node dissection should not be performed [1,2]. Axillary lymph node dissection, however, remains controversial in breast cancer patients. In 2013, the 13th St. Gallen International Breast Cancer Consensus Conference recommended that sentinel lymph node biopsy in certain breast cancer patients, and axillary lymph node dissection should be avoided [18]. In our study, a majority of breast cancer patients received complete mastectomy (96.1%), and axillary lymph node dissection was simultaneously performed, which was outside the Z0011 selection criteria (i.e., who still need ALND). Our results showed that in patients with different pT stages, and those with positive lymph nodes, a larger number of NLNs was associated with lower mortality. Furthermore, a more extensive axillary dissection may lead to unnecessary morbidity, and thus the balance between risks and benefits of more extensive axillary surgery must be considered on a patient-by-patient basis. There are limitations of this study.