Construction and Validation of a Nomogram Based on the Log Odds of Positive Lymph Nodes to Predict the Prognosis of Medullary Thyroid Carcinoma After Surgery

Tang, Jiajia; Jiang, Shimin; Gao, Luying; Xi, Xuehua; Zhao, Ruina; Lai, Xingjian; Zhang, Bo; Jiang, Yuxin

doi:10.1245/s10434-020-09567-3

Cited by 38 publications

(36 citation statements)

References 32 publications

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“…According to the American Joint Committee on Cancer (AJCC), the lymph node stages in patients with MTC are classified as follows: pN0, no evidence of locoregional lymph node metastasis; pN1a, metastasis to level VI or VII lymph nodes; and pN1b, metastasis to the unilateral, bilateral, or contralateral neck or retropharyngeal lymph nodes [ 5 ]. The AJCC staging system only contains categories for lymph node compartments; therefore, previous studies have attempted to quantitatively assess lymph node status [ 6 , 7 , 8 , 9 ]. In some of them, increased positive lymph node ratio (LNR) in the postoperative evaluation was suggested to be associated with poor prognosis [ 10 , 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

Metastatic Lymph Node Ratio for Predicting Recurrence in Medullary Thyroid Cancer

Kim

Park

et al. 2021

Cancers

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The lymph node ratio (LNR) has been investigated as a prognostic factor in many different types of cancers, including differentiated thyroid cancer; however, reports regarding medullary thyroid cancer (MTC) are limited. Therefore, this study aims to evaluate LNR as a risk factor for structural recurrence in patients with MTC. Medical records of patients treated for MTC in a single tertiary center between 1995 and 2017 were retrospectively reviewed. LNR is defined as the number of metastatic lymph nodes or lymph node metastases (LNM) divided by the number of retrieved lymph nodes or lymph node yield (LNY). In the survival analysis, recurrence-free survival was defined as the time from the date of total thyroidectomy to recurrence or last follow-up. To identify risk factors influencing structural recurrence, univariable and multivariable Cox proportional hazard models were used. A total of 132 patients were enrolled. The mean age of study participants was 49.7 years, and 86 patients (65%) were women. Structural recurrence was identified in 39 patients at the end of the study period, and the median follow-up period was 8.7 years. In univariable analyses, gross extra thyroidal extension, N stage, postoperative serum calcitonin and carcinoembryonic antigen (CEA) levels, and LNR were significant (p < 0.05) predictors of structural recurrence. In multivariable analysis, postoperative serum calcitonin, postoperative serum CEA, and LNR were identified as a predictor of disease-free survival (p < 0.05). LNR can potentially predict structural recurrence as a quantitative evaluation tool for lymph node metastasis in patients with MTC.

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Section: Introductionmentioning

confidence: 99%

Metastatic Lymph Node Ratio for Predicting Recurrence in Medullary Thyroid Cancer

Kim

Park

et al. 2021

Cancers

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“…This conclusion is consistent with that of many previous studies, but the specific staging method for LODDS is still inconclusive. For example, the LODDS stage of medullary thyroid cancer ( 13 ) is LODDS1 ( ≤ −0.9), LODDS2 (−0.9~-0.1) and LODDS3 (>-0.1); for gastric cancer ( 26 ) is LODDS1 ( ≤ -3), LODDS2 (−3~-1), LODDS3 (−1~3) and LODDS4 (> 3); perihilar cholangiocarcinoma ( 27 ) is LODDS1 (−3.11~-1.32), LODDS2 (−1.32~-0.39) and LODDS3 (−0.39~2.45); gallbladder cancer ( 28 ) is LODDS1 ( ≤ -1.5), LODDS2 (−1.5~0), LODDS3 (0~1.5) and LODDS3 (≥ 1.5). In this study, the LODDS stages of DCC were LODDS1 ( ≤ -2.00), LODDS2 (−2.00~0.29), and LODDS3 (>0.29).…”

Section: Discussionmentioning

confidence: 99%

“…However, staging regional LN metastasis based on PLNN and ignoring the actual number of examined lymph nodes (ELNN) during surgery may lead to bias. Therefore, some scholars have proposed that lymph node ratio (LNR) and log odds of positive lymph nodes (LODDS) are better staging criteria for LN metastasis than N stage in a variety of tumors, such as thyroid, colorectal, and pancreatic cancer (12)(13)(14)(15). LNR is defined as the ratio of PLNN to ELNN; LODDS is defined as the log of the quotient of the PLNN and the number of negative LNs (14)(15)(16).…”

Section: Introductionmentioning

confidence: 99%

A Nomogram Based on the Log Odds of Positive Lymph Nodes Predicts the Prognosis of Patients With Distal Cholangiocarcinoma After Surgery

Sun

et al. 2021

Front. Surg.

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Background: Lymph node (LN) metastasis is considered one of the most important risk factors affecting the prognosis of distal cholangiocarcinoma (DCC). This study aimed to demonstrate the superiority of log odds of positive lymph nodes (LODDS) compared with other LN stages, and to establish a novel prognostic nomogram to predict the cancer-specific survival (CSS) of DCC.Methods: From the Surveillance, Epidemiology and End Results (SEER) database, the data of 676 patients after DCC radical operation were screened, and patients were randomly divided into training (n = 474) and validation sets (n = 474). The prognostic evaluation performance of the LODDS and American Joint Commission on Cancer (AJCC) N stage and lymph node ratio (LNR) were compared using the Akaike information criteria, receiver operating characteristic area under the curve (AUC), and C-index. Multivariate Cox analysis was used to screen independent risk factors, and a LODDS-based nomogram prognostic staging model was established. The nomogram's precision was verified by C-index, calibration curves, and AUC, and the results were compared with those of the AJCC TNM staging system.Results:Compared with the other two stages of LN metastasis, LODDS was most effective in predicting CSS in patients with DCC. Multivariate analysis proved that LODDS, histologic grade, SEER historic stage, and tumor size were independent risk factors for DCC. The C-index of the nomogram, based on the above factors, in the validation set was 0.663. The 1-, 3-, and 5-y AUCs were 0.735, 0.679, and 0.745, respectively. Its good performance was also verified by calibration curves. In addition, the C-index and Kaplan-Meier analysis showed that the nomogram performed better than the AJCC TNM staging system.Conclusion:For postoperative patients with DCC, the LODDS stage yielded better prognostic efficiency than the AJCC N and LNR stages. Compared with the AJCC TNM staging system, the nomogram, based on the LODDS, demonstrated superior performance.

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“…Because the sample size and number of samples in the database are very large, our results are reliable. We examined not only AEG but also other human cancers using data from the SEER database [ 15 , 17 , 18 , 23 , 24 ]. We compared the number of patients with different types of cancer described in the SEER database over the last two years ( Supplementary Table 2 ).…”

Section: Discussionmentioning

confidence: 99%

A novel risk score system for prognostic evaluation in adenocarcinoma of the oesophagogastric junction: a large population study from the SEER database and our center

et al. 2021

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Background The incidence rate of adenocarcinoma of the oesophagogastric junction (AEG) has significantly increased over the past decades, with a steady increase in morbidity. The aim of this study was to explore a variety of clinical factors to judge the survival outcomes of AEG patients. Methods We first obtained the clinical data of AEG patients from the Surveillance, Epidemiology, and End Results Program (SEER) database. Univariate and least absolute shrinkage and selection operator (LASSO) regression models were used to build a risk score system. Patient survival was analysed using the Kaplan-Meier method and the log-rank test. The specificity and sensitivity of the risk score were determined by receiver operating characteristic (ROC) curves. Finally, the internal validation set from the SEER database and external validation sets from our center were used to validate the prognostic power of this model. Results We identified a risk score system consisting of six clinical features that can be a good predictor of AEG patient survival. Patients with high risk scores had a significantly worse prognosis than those with low risk scores (log-rank test, P-value < 0.0001). Furthermore, the areas under ROC for 3-year and 5-year survival were 0.74 and 0.75, respectively. We also found that the benefits of chemotherapy and radiotherapy were limited to stage III/IV AEG patients in the high-risk group. Using the validation sets, our novel risk score system was proven to have strong prognostic value for AEG patients. Conclusions Our results may provide new insights into the prognostic evaluation of AEG.

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Construction and Validation of a Nomogram Based on the Log Odds of Positive Lymph Nodes to Predict the Prognosis of Medullary Thyroid Carcinoma After Surgery

Cited by 38 publications

References 32 publications

Metastatic Lymph Node Ratio for Predicting Recurrence in Medullary Thyroid Cancer

Metastatic Lymph Node Ratio for Predicting Recurrence in Medullary Thyroid Cancer

A Nomogram Based on the Log Odds of Positive Lymph Nodes Predicts the Prognosis of Patients With Distal Cholangiocarcinoma After Surgery

A novel risk score system for prognostic evaluation in adenocarcinoma of the oesophagogastric junction: a large population study from the SEER database and our center

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