N, LNR or LODDS: Which Is the Most Appropriate Lymph Node Classification Scheme for Patients with Radically Resected Pancreatic Cancer?

Abstract

Background: Even though numerous novel lymph node (LN) classification schemes exist, an extensive comparison of their performance in patients with resected pancreatic ductal adenocarcinoma (PDAC) has not yet been performed. Method: We investigated the prognostic performance and discriminative ability of 25 different LN ratio (LNR) and 27 log odds of metastatic LN (LODDS) classifications by means of Cox regression and C-statistic in 319 patients with resected PDAC. Regression models were adjusted for age, sex, T category, grading, localization, presence of metastatic disease, positivity of resection margins, and neoadjuvant therapy. Results: Both LNR or LODDS as continuous variables were associated with advanced tumor stage, distant metastasis, positive resection margins, and PDAC of the head or corpus. Two distinct LN classifications, one LODDS and one LNR, were found to be superior to the N category in the complete patient collective. However, only the LODDS classification exhibited statistically significant, gradually increasing HRs of their subcategories and at the same time significantly higher discriminative potential in the subgroups of patients with PDAC of the head or corpus and in patients with tumor free resection margins or M0 status, respectively. On this basis, we built a clinically helpful nomogram to estimate the prognosis of patients after radically resected PDAC. Conclusion: One LNR and one LODDS classification scheme were found to out-perform the N category in terms of both prognostic performance and discriminative ability, in distinct patient subgroups, with reference to OS in patients with resected PDAC.

Nomogram for Predicting Post-progression-free Survival in Patients with Recurrent Pancreatic Ductal Adenocarcinoma after Radical Surgery

“…Second, more precise results would be established in future exploration when a larger sample size was available. Third, some modi ed described methods for lymph node metastasis, such as LNR and LODDS, have already been proposed in some research 52 . However, we still referred to the description of lymph node metastasis from the AJCC guidelines in the present study.…”

New Personal Model for Forecasting the Outcome of Patients with Histological Grade III-IV Colorectal Cancer Based on Regional Lymph Nodes

“…However, the AJCC TNM staging system does not take ELNs into consideration. Thus, LNR and LODDS should be introduced [ 14 , 32 , 33 ].…”

“…However, the number of examined regional lymph nodes (ELNs) in the N stage was not considered. Hence, the lymph node ratio (LNR) was proposed as a supplement to the N staging system [ 14 ].…”

The Role of Alternative Lymph Node Classification Systems in Gastroenteropancreatic Neuroendocrine Neoplasms (GEP-NEN): Superiority of a LODDS Scheme Over N Category in Pancreatic NEN (pNEN)

“…Therefore, a base model included the following covariates: Patient age ( < median versus ≥ median) and sex (female versus male), tumor localization (foregut versus midgut or hindgut), extent of tumor (T3 + 4 versus T1 + 2), grading (G1 versus G2 or G3), and presence of metastatic disease (M0 versus M1). Applying this multivariate base model, we estimated hazard ratios (HR) for each lymph node classification and assessed model discrimination using C-statistics, as described recently [14][15][16]. Briefly, for each model, the difference between the C-index of the model containing the N category and any other model with an alternative lymph node classification was compared.…”