Log odds of positive lymph nodes is prognostically equivalent to lymph node ratio in non-metastatic colon cancer

Abstract

Background: Globally, colorectal cancer (CRC) is the third and second leading cancer in men and women respectively with 600,000 deaths per year. Traditionally, clinicians have relied solely on nodal disease involvement, and measurements such as lymph node ratio (LNR; the ratio of metastatic/positive lymph nodes to total number of lymph nodes examined), when determining patient prognosis in CRC. The log odds of positive lymph nodes (LODDS) is a logistic transformation formula that uses pathologic lymph node data to stratify survival differences among patients within a single stage of disease. This formula allows clinicians to identify whether patients with clinically aggressive tumours fall into higher-risk groups regardless of nodal positivity and can potentially guide adjuvant treatment modalities. The aim of this study was to investigate whether LODDS in colon cancer provides better prognostication compared to LNR. Methods: A retrospective study of patients on the prospectively maintained Cabrini Monash University Department of Surgery colorectal neoplasia database, incorporating data from hospitals in Melbourne Australia, identified patients entered between January 2010 and March 2016. Association of LODDS and LNR with clinical variables were analysed. Disease-free (DFS) and overall (OS) survival were investigated with Cox regression and Kaplan-Meier survival analyses. Results: There were 862 treatment episodes identified in the database (402 male, 47%). The median patient age was 73 (range 22-100 years). There were 799 colonic cancers and 63 rectosigmoid cancers. The lymph node yield (LNY) was suboptimal (< 12) in 168 patients (19.5%) (p = 0.05). The 5-year OS for the different LNR groups were 86, 91 and 61% (p < 0.001) for LNR 0 (655 episodes), LNR 1 (128 episodes) and LNR 2 (78 episodes), respectively. For LODDS, they were 85, 91 and 61% (p < 0.001) in LODDS 0 (569 episodes), LODDS 1 (217 episodes) and LODDS 2 (75 episodes) groups (p < 0.001). Overall survival rates were comparable between the LNR and LODDS group and for LNY < 12 and stage III patients when each were sub-grouped by LODDS and LNR. Conclusion: This study has shown for that the prognostic impact of LODDS is comparable to LNR for colon cancer patients. Accordingly, LNR is recommended for prognostication given its ease of calculation.

Metastatic Lymph Node Ratio for Predicting Recurrence in Medullary Thyroid Cancer

“…LODDS was also used, not N stage or the number of pathologically positive lymph nodes, in the nomogram for the risk assessment of recurrence in a previous study on MTC [ 9 ]. However, LNR is thought to be easier for intuitive understanding in clinical situations because LODDS entails additional mathematical calculations [ 28 ]. As LNR provided sufficient statistical predictive power in the analysis results, further analysis of LODSS was not addressed in this study.…”

Dynamic nomograms combining N classification with ratio-based nodal classifications to predict long-term survival for patients with lung adenocarcinoma after surgery: a SEER population-based study

“…We found that NPLN, LODDS and LNR were all independent predictive factors, and LNR was superior to NPLN and LODDS by demonstrating better performance in homogeneity, statistical model fit, discrimination, and accuracy of survival prediction. LODDS was thought to be prognostically superior or equivalent to lymph node ratio in previous lung or digestive cancer studies [ 10 – 13 , 17 , 23 ]. Deng et al studied the predictive performance of LODDS and LNR in patients with node-positive NSCLC and chose 10 as a cutoff value of NDLN [ 11 ].…”

“…Although NDLN and NPLN do not contribute to N classification, several studies have confirmed that higher values of NPLN, log odds of positive lymph nodes (LODDS, calculated using the formula: LODDS¼ log NPLN þ0:50 NDLN −NPLN þ0:5 ) or lymph node ratio (LNR, calculated using the formula: LNR¼ NPLN NDLN ) were related to worse prognosis for NSCLC or several other types of malignant tumors [10][11][12][13]. However, of these node classifications, which can obtain the most precise prognosis in lung AC is unclear.…”

Development and Validation of the Individualized Prognostic Nomograms in Patients With Right- and Left-Sided Colon Cancer

“…LODDS was defined as the loge [(positive nodes + 0.5)/(negative nodes + 0.5)], namely, the log of the ratio between the number of positive lymph nodes and the number of negative lymph nodes ( 22 ). X-tile (Yale University, 3.6.1) was also performed to calculate the cutoff value for LODDS group.…”