Advertisement

International Urology and Nephrology

, Volume 52, Issue 1, pp 87–95 | Cite as

Comparison of different lymph node staging schemes in prostate cancer patients with lymph node metastasis

  • Shengming Jin
  • Junjie Wang
  • Yijun Shen
  • Hualei Gan
  • Peihang Xu
  • Yu Wei
  • Jiaming Wei
  • Junlong Wu
  • Beihe Wang
  • Jun Wang
  • Chen Yang
  • Yao ZhuEmail author
  • Dingwei YeEmail author
Urology - Original Paper
  • 63 Downloads

Abstract

Purpose

In addition to standard TNM N staging, lymph node ratio (LNR) and log odds of metastatic lymph node (LODDS) staging methods have been developed for cancer staging. We compared the prognostic performance of the total number of lymph nodes examined (TNLE), number of metastatic lymph node (NMLN), LNR, and LODDS in prostate cancer.

Methods

Data from 1400 patients diagnosed with prostate cancer between 2004 and 2009 who underwent lymphadenectomy were extracted from the Surveillance Epidemiology and End Results database. Kaplan–Meier methods and multivariable Cox regression analysis were used to evaluate the prognostic value of different lymph node staging schemes in patients with lymph node metastasis.

Results

Univariate analysis showed that age, T stage, radiotherapy history, Gleason score, LNR classification, LODDS classification, and NMLN except TNLE classification were significant prognostic factors for overall survival. In multivariate analysis, LNR classification, LODDS classification, and NMLN but TNLE classification remained significant prognostic factors for overall survival. LNR classification had the highest C-index (0.672; 95% confidence interval [CI]: 0.609–0.734) and the lowest Akaike information criterion (AIC) (4057.018), indicating the best prognostic performance. Scatter plots showed that LODDS increased with increasing LNR, exhibiting a strong overall correlation between these two lymph node staging methods (r2 = 0.9072). LNR and LODDS generally increased with increasing NMLN, although the correlation was relatively low.

Conclusion

Our results indicate that LNR and LODDS may be better predictors of overall survival than the AJCC/UICC N category in patients undergoing curative surgery for prostate cancer.

Keywords

Prostate cancer Lymph node staging Lymph node ratio Log odds Prognosis 

Notes

Acknowledgements

The authors would like to thank all patients involved in this study and all the staff working for SEER database. This work was funded by the National Natural Science Foundation of China (81572531). The funding source provided financial support for the study and did not have any other involvement in this study. In addition, we thank Clare Cox, PhD, from Liwen Bianji, Edanz Editing China (www.liwenbianji.cn/ac), for editing the English text of a draft of this manuscript.

Compliance with ethical standards

Conflict of interest

None of the authors declare competing financial interests.

Ethical approval

All the procedures performed in studies involving human participants were in accordance with the ethical standards of the Research Ethics Committee of Shanghai Cancer Center, Fudan University, China and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This study was approved by the Research Ethics Committee of Shanghai Cancer Center, Fudan University, China according to the provisions of the Declaration of Helsinki (as revised in Fortaleza, Brazil, October 2013). All patients were identified from the public SEER database. Thus, informed consent was not required.

Informed consent

The public SEER databases have obtained informed consent from all individual participants included in the SEER database before. Therefore, we did not need extra informed consent of the patients. In addition, patients in this study were all anonymous and other personal information was also erased.

Supplementary material

11255_2019_2294_MOESM1_ESM.docx (17 kb)
Supplementary material 1 (DOCX 16 kb)

References

  1. 1.
    Siegel RL, Miller KD, Jemal A (2018) Cancer statistics. CA Cancer J Clin 68(1):7–30.  https://doi.org/10.3322/caac.21442 CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Miller KD, Siegel RL, Lin CC, Mariotto AB, Kramer JL, Rowland JH, Stein KD, Alteri R, Jemal A (2016) Cancer treatment and survivorship statistics, 2016. CA Cancer J Clin 66(4):271–289.  https://doi.org/10.3322/caac.21349 CrossRefPubMedGoogle Scholar
  3. 3.
    Daneshmand S, Quek ML, Stein JP, Lieskovsky G, Cai J, Pinski J, Skinner EC, Skinner DG (2004) Prognosis of patients with lymph node positive prostate cancer following radical prostatectomy: long-term results. J Urol 172(6 Pt 1):2252–2255.  https://doi.org/10.1097/01.ju.0000143448.04161.cc CrossRefPubMedGoogle Scholar
  4. 4.
    Amin MB, Edge Stephen B (eds) (2017) AJCC cancer staging manual. Springer, BerlinGoogle Scholar
  5. 5.
    Sakata J, Shirai Y, Wakai T, Ajioka Y, Hatakeyama K (2010) Number of positive lymph nodes independently determines the prognosis after resection in patients with gallbladder carcinoma. Ann Surg Oncol 17(7):1831–1840.  https://doi.org/10.1245/s10434-009-0899-1 CrossRefPubMedGoogle Scholar
  6. 6.
    Marchet A, Mocellin S, Ambrosi A, Morgagni P, Garcea D, Marrelli D, Roviello F, de Manzoni G, Minicozzi A, Natalini G, De Santis F, Baiocchi L, Coniglio A, Nitti D (2007) The ratio between metastatic and examined lymph nodes (N ratio) is an independent prognostic factor in gastric cancer regardless of the type of lymphadenectomy: results from an Italian multicentric study in 1853 patients. Ann Surg 245(4):543–552.  https://doi.org/10.1097/01.sla.0000250423.43436.e1 CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Marchet A, Mocellin S, Ambrosi A, de Manzoni G, Di Leo A, Marrelli D, Roviello F, Morgagni P, Saragoni L, Natalini G, De Santis F, Baiocchi L, Coniglio A, Nitti D (2008) The prognostic value of N-ratio in patients with gastric cancer: validation in a large, multicenter series. Eur J Surg Oncol 34(2):159–165.  https://doi.org/10.1016/j.ejso.2007.04.018 CrossRefPubMedGoogle Scholar
  8. 8.
    Arslan NC, Sokmen S, Canda AE, Terzi C, Sarioglu S (2014) The prognostic impact of the log odds of positive lymph nodes in colon cancer. Colorectal Dis 16(11):O386–O392.  https://doi.org/10.1111/codi.12702 CrossRefPubMedGoogle Scholar
  9. 9.
    Huang B, Chen C, Ni M, Mo S, Cai G, Cai S (2016) 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. Int J Surg (London, England) 32:24–30.  https://doi.org/10.1016/j.ijsu.2016.06.002 CrossRefGoogle Scholar
  10. 10.
    Calero A, Escrig-Sos J, Mingol F, Arroyo A, Martinez-Ramos D, de Juan M, Salvador-Sanchis JL, Garcia-Granero E, Calpena R, Lacueva FJ (2015) Usefulness of the log odds of positive lymph nodes to predict and discriminate prognosis in gastric carcinomas. J Gastrointest Surg 19(5):813–820.  https://doi.org/10.1007/s11605-014-2728-5 CrossRefPubMedGoogle Scholar
  11. 11.
    Aurello P, Petrucciani N, Nigri GR, La Torre M, Magistri P, Tierno S, D’Angelo F, Ramacciato G (2014) Log odds of positive lymph nodes (LODDS): what are their role in the prognostic assessment of gastric adenocarcinoma? J Gastrointest Surg 18(7):1254–1260.  https://doi.org/10.1007/s11605-014-2539-8 CrossRefPubMedGoogle Scholar
  12. 12.
    Wu SG, Sun JY, Yang LC, Zhou J, Li FY, Li Q, Lin HX, Lin Q, He ZY (2015) Prognosis of patients with esophageal squamous cell carcinoma after esophagectomy using the log odds of positive lymph nodes. Oncotarget 6(34):36911–36922.  https://doi.org/10.18632/oncotarget.5366 CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Wen J, Ye F, He X, Li S, Huang X, Xiao X, Xie X (2016) Development and validation of a prognostic nomogram based on the log odds of positive lymph nodes (LODDS) for breast cancer. Oncotarget 7(15):21046–21053.  https://doi.org/10.18632/oncotarget.8091 CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Song YX, Gao P, Wang ZN, Tong LL, Xu YY, Sun Z, Xing CZ, Xu HM (2011) Which is the most suitable classification for colorectal cancer, log odds, the number or the ratio of positive lymph nodes? PLoS One 6(12):e28937.  https://doi.org/10.1371/journal.pone.0028937 CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Rosenberg R, Engel J, Bruns C, Heitland W, Hermes N, Jauch KW, Kopp R, Putterich E, Ruppert R, Schuster T, Friess H, Holzel D (2010) The prognostic value of lymph node ratio in a population-based collective of colorectal cancer patients. Ann Surg 251(6):1070–1078.  https://doi.org/10.1097/SLA.0b013e3181d7789d CrossRefPubMedGoogle Scholar
  16. 16.
    Berger AC, Sigurdson ER, LeVoyer T, Hanlon A, Mayer RJ, Macdonald JS, Catalano PJ, Haller DG (2005) Colon cancer survival is associated with decreasing ratio of metastatic to examined lymph nodes. J Clin Oncol 23(34):8706–8712.  https://doi.org/10.1200/jco.2005.02.8852 CrossRefPubMedGoogle Scholar
  17. 17.
    Kornprat P, Pollheimer MJ, Lindtner RA, Schlemmer A, Rehak P, Langner C (2011) Value of tumor size as a prognostic variable in colorectal cancer: a critical reappraisal. Am J Clin Oncol 34(1):43–49.  https://doi.org/10.1097/COC.0b013e3181cae8dd CrossRefPubMedGoogle Scholar
  18. 18.
    Wang J, Hassett JM, Dayton MT, Kulaylat MN (2008) The prognostic superiority of log odds of positive lymph nodes in stage III colon cancer. J Gastrointest Surg 12(10):1790–1796.  https://doi.org/10.1007/s11605-008-0651-3 CrossRefPubMedGoogle Scholar
  19. 19.
    Spolverato G, Ejaz A, Kim Y, Squires MH, Poultsides G, Fields RC, Bloomston M, Weber SM, Votanopoulos K, Acher AW, Jin LX, Hawkins WG, Schmidt C, Kooby DA, Worhunsky D, Saunders N, Cho CS, Levine EA, Maithel SK, Pawlik TM (2015) Prognostic performance of different lymph node staging systems after curative intent resection for gastric adenocarcinoma. Ann Surg 262(6):991–998.  https://doi.org/10.1097/sla.0000000000001040 CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  • Shengming Jin
    • 1
    • 2
  • Junjie Wang
    • 1
    • 2
  • Yijun Shen
    • 1
    • 2
  • Hualei Gan
    • 2
    • 3
  • Peihang Xu
    • 1
    • 2
  • Yu Wei
    • 1
    • 2
  • Jiaming Wei
    • 1
    • 2
  • Junlong Wu
    • 1
    • 2
  • Beihe Wang
    • 1
    • 2
  • Jun Wang
    • 1
    • 2
  • Chen Yang
    • 4
  • Yao Zhu
    • 1
    • 2
    Email author
  • Dingwei Ye
    • 1
    • 2
    Email author
  1. 1.Department of UrologyFudan University Shanghai Cancer CenterShanghaiPeople’s Republic of China
  2. 2.Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiPeople’s Republic of China
  3. 3.Department of PathologyFudan University Shanghai Cancer CenterShanghaiPeople’s Republic of China
  4. 4.Department of Urology, Huashan HospitalFudan UniversityShanghaiPeople’s Republic of China

Personalised recommendations