Log odds of positive lymph nodes is a superior prognostic indicator in stage III rectal cancer patients: A retrospective analysis of 17,632 patients in the SEER database

Huang, Ben; Chen, Chen; Ni, Ming; Mo, Shaobo; Cai, Guoxiang; Cai, Sanjun

doi:10.1016/j.ijsu.2016.06.002

Cited by 30 publications

(18 citation statements)

References 23 publications

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“…As a novel nodal assessment approach, LODDS has been proposed because of the limitation of the N descriptor and LNR in the prediction of prognosis. Also, it has been identified to be superior to N descriptor and LNR in many cancers including esophageal carcinoma 16‐21 . However, the prognostic accuracy of LODDS for patients with esophageal carcinoma who received neoadjuvant therapy remains unknown.…”

Section: Discussionmentioning

confidence: 99%

“…However, it has been reported that in some tumors such as rectal and gastric cancers, LNR lost its prognostic efficacy in survival prediction for patients without metastatic lymph nodes retrieved 8,15 . Recently, the log odds of positive lymph nodes (LODDS), defined as the natural logarithm of the ratio of a metastatic lymph node to a nonmetastatic lymph node, 16 were found to be effective in prediction of survival outcomes for rectum, gastric, pancreatic, breast, and esophageal cancers 16‐21 . To date, the value of LODDS in the prediction of survival outcomes for patients with esophageal carcinoma who received neoadjuvant therapy has never been elucidated.…”

Section: Introductionmentioning

confidence: 99%

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Log odds of positive lymph nodes predicts survival in patients treated with neoadjuvant therapy followed by esophagectomy

Chen

Wang

et al. 2020

Journal of Surgical Oncology

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Background and Objectives: We aimed to evaluate the efficacy of the log odds of positive lymph nodes (LODDS) in survival prediction of patients with esophageal carcinoma receiving neoadjuvant therapy, compared with N descriptor and positive lymph node ratio (LNR). Methods: Patients with esophageal carcinoma receiving neoadjuvant therapy from 2004 to 2015 were reviewed in Surveillance, Epidemiology, and End Results database. The receiver operating characteristics curve and area under the curve (AUC) were used to compare discriminatory power among N descriptor, LNR, and LODDS. The goodness of fit was measured using the −2 log-likelihood ratio (-2LLR). Results: About 2239 patients with a 22 months median follow-up and a 37.8% 5-year overall survival rate were included. LODDS had the best discriminatory power and goodness of fit (LODDS vs N descriptor, AUC 0.666 vs 0.626, −2LLR 15 680.402 vs 15 746.162; LODDS vs LNR, AUC 0.666 vs 0.635, −2LLR 15 680.402 vs 15 712.379; all P < .001). LODDS was the best for fewer than 15 lymph nodes retrieved (LODDS vs N descriptor, AUC 0.652 vs 0.618, P < .001; LODDS vs LNR, AUC 0.652 vs 0.625, P = .005). The prognosis of patients without metastatic nodes could be discriminated by LODDS. Conclusions: LODDS could better predict survival of patients with esophageal carcinoma receiving neoadjuvant therapy. K E Y W O R D S esophageal carcinoma, log odds of positive lymph nodes, neoadjuvant therapy

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Log odds of positive lymph nodes predicts survival in patients treated with neoadjuvant therapy followed by esophagectomy

Chen

Wang

et al. 2020

Journal of Surgical Oncology

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“…Several studies have recently suggested the limitation of traditional LNM status in prognosis stratification of stage III patients, strongly urging us to investigate whether the Fn level has the capacity to provide an accurate stratification for these patients. 39 , 40 We therefore subsequently performed a subgroup analysis and found that Fn level could stratify the CSS and DFS of both stage IIIB and IIIC patients, but failed in stage IIIA patients. This result suggested that Fn level might be an effective prognostic indicator only for stage IIIB or IIIC patients.…”

Section: Discussionmentioning

confidence: 99%

Clinical significance of <em>Fusobacterium nucleatum</em>, epithelial–mesenchymal transition, and cancer stem cell markers in stage III/IV colorectal cancer patients

Yan¹,

Liu²,

Li³

et al. 2017

OTT

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Colorectal cancer (CRC) is a common digestive malignancy and emerging studies have closely linked its initiation and development with gut microbiota changes. Fusobacterium nucleatum (Fn) has been recently identified as a pathogenic bacteria for CRC; however, its prognostic significance for patients is poorly investigated and is less for patients within late stage. Therefore, in this study, we made efforts to analyze its level and prognostic significance in a retrospective cohort of 280 stage III/IV CRC patients. We found that the Fn level was abnormally high in tumor tissues and correlated with tumor invasion, lymph node metastasis status, and distant metastasis. We also identified it as an independent adverse prognostic factor for cancer-specific survival (CSS) and disease-free survival (DFS). The following subgroup analysis indicated that Fn level could stratify CSS and DFS in stage IIIB/C and IV patients but failed in stage IIIA patients. In addition, stage III/IV patients with low Fn level were found to benefit more from adjuvant chemotherapy than those with high Fn level, in terms of DFS. Finally, we analyzed the expression and clinical significance of epithelial-to-mesenchymal transition (EMT) markers (E-cadherin and N-cadherin) and cancer stem cell (CSC) markers (Nanog, Oct-4, and Sox-2) in CRC tissues. The results indicated that N-cadherin, Nanog, Oct-4, and Sox-2 were adverse prognostic factors in these patients, while the opposite was true for E-cadherin. More importantly, expression of E-cadherin, N-cadherin, and Nanog was significantly correlated with Fn level in tumor tissues, suggesting the potential involvement of Fn in EMT-CSC cross talk during CRC progression. Taken together, these findings indicate that Fn is a novel predictive biomarker for clinical management in stage III/IV patients, and targeting Fn may be an effective adjuvant approach for preventing CRC metastasis and chemotherapy resistance.

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“…Similarly, Persiani et al used Cox regression to demonstrate the same relationship with the LODDS results, but not with those from LNR, in a series of 258 patients with non-metastatic colon cancer [ 24 ]. In a study including 17,632 cases, Huang et al demonstrated that the LODDS method was more accurate than the LNR when calculating specific survival rates [ 25 ]. On the other hand, other authors have demonstrated that both methods are directly related to survival [ 9 , 10 ].…”

Section: Discussionmentioning

confidence: 99%

The lymph node status as a prognostic factor in colon cancer: comparative population study of classifications using the logarithm of the ratio between metastatic and nonmetastatic nodes (LODDS) versus the pN-TNM classification and ganglion ratio systems

2018

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BackgroundpN stage in the TNM classification has been the “gold standard” for lymph node staging of colorectal carcinomas, but this system recommends collecting at least 12 lymph nodes for the staging to be reliable. However, new prognostic staging systems have been devised, such as the ganglion quotients or lymph node ratios and natural logarithms of the lymph node odds methods. The aim of this study was to establish and validate the predictive and prognostic ability of the lymph node ratios and natural logarithms of the lymph node odds staging systems and to compare them to the pN nodal classification of the TNM system in a population sample of patients with colon cancer.MethodsA multicentric population study between January 2004 and December 2007. The inclusion criteria were that the patients were: diagnosed with colon cancer, undergoing surgery with curative intent, and had a complete anatomopathological report. We excluded patients with cancer of the rectum or caecal appendix with metastases at diagnosis. Survival analysis was performed using the Kaplan–Meier actuarial method and the Log-Rank test was implemented to estimate the differences between groups in terms of overall survival and disease-free survival. Multivariate survival analysis was performed using Cox regression.ResultsWe analysed 548 patients. For the overall survival, the lymph node ratios and natural logarithms of the lymph node odds curves were easier to discriminate because their separation was clearer and more balanced. For disease-free survival, the discrimination between the pN0 and pN1 groups was poor, but this phenomenon was adequately corrected for the lymph node ratios and natural logarithms of the lymph node odds curves which could be sufficiently discriminated to be able to estimate the survival prognosis.ConclusionsLymph node ratios and natural logarithms of the lymph node odds techniques can more precisely differentiate risk subgroups from within the pN groups. Of the three methods tested in this study, the natural logarithms of the lymph node odds was the most accurate for staging non-metastatic colon cancer. Thus helping to more precisely adjust and individualise the indication for adjuvant treatments in these patients.

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Log odds of positive lymph nodes is a superior prognostic indicator in stage III rectal cancer patients: A retrospective analysis of 17,632 patients in the SEER database

Abstract: The prognostic value of LNR can be confounded by LODDS. In stage III rectal cancer patients, LODDS has superior discrimination power over LNR and can more accurately evaluate CSS.

Cited by 30 publications

References 23 publications

Log odds of positive lymph nodes predicts survival in patients treated with neoadjuvant therapy followed by esophagectomy

Log odds of positive lymph nodes predicts survival in patients treated with neoadjuvant therapy followed by esophagectomy

Clinical significance of <em>Fusobacterium nucleatum</em>, epithelial–mesenchymal transition, and cancer stem cell markers in stage III/IV colorectal cancer patients

The lymph node status as a prognostic factor in colon cancer: comparative population study of classifications using the logarithm of the ratio between metastatic and nonmetastatic nodes (LODDS) versus the pN-TNM classification and ganglion ratio systems

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Log odds of positive lymph nodes is a superior prognostic indicator in stage III rectal cancer patients: A retrospective analysis of 17,632 patients in the SEER database

Abstract: The prognostic value of LNR can be confounded by LODDS. In stage III rectal cancer patients, LODDS has superior discrimination power over LNR and can more accurately evaluate CSS.

Cited by 30 publications

References 23 publications

Log odds of positive lymph nodes predicts survival in patients treated with neoadjuvant therapy followed by esophagectomy

Log odds of positive lymph nodes predicts survival in patients treated with neoadjuvant therapy followed by esophagectomy

Clinical significance of <em>Fusobacterium nucleatum</em>, epithelial&ndash;mesenchymal transition, and cancer stem cell markers in stage III/IV colorectal cancer patients

The lymph node status as a prognostic factor in colon cancer: comparative population study of classifications using the logarithm of the ratio between metastatic and nonmetastatic nodes (LODDS) versus the pN-TNM classification and ganglion ratio systems

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Clinical significance of <em>Fusobacterium nucleatum</em>, epithelial–mesenchymal transition, and cancer stem cell markers in stage III/IV colorectal cancer patients