Skip to main content

Advertisement

SpringerLink
Log in

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

  • Urology - Original Paper
  • Published:
International Urology and Nephrology Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  4. Amin MB, Edge Stephen B (eds) (2017) AJCC cancer staging manual. Springer, Berlin

    Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  PubMed Central  Google Scholar 

  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

    Article  CAS  PubMed  Google Scholar 

  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

    Article  CAS  PubMed  Google Scholar 

  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

    Article  CAS  Google Scholar 

  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

    Article  CAS  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  PubMed Central  Google Scholar 

  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

    Article  PubMed  PubMed Central  Google Scholar 

  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

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

Download references

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.

Author information

Author notes

  1. Shengming Jin, Junjie Wang and Yijun Shen contributed equally to this work.

Authors and Affiliations

  1. Department of Urology, Fudan University Shanghai Cancer Center, No.270 at Dong’an Road, Xuhui District, Shanghai, 200032, People’s Republic of China

    Shengming Jin, Junjie Wang, Yijun Shen, Peihang Xu, Yu Wei, Jiaming Wei, Junlong Wu, Beihe Wang, Jun Wang, Yao Zhu & Dingwei Ye

  2. Department of Oncology, Shanghai Medical College, Fudan University, No.130 at Dong’an Road, Xuhui District, Shanghai, 200032, People’s Republic of China

    Shengming Jin, Junjie Wang, Yijun Shen, Hualei Gan, Peihang Xu, Yu Wei, Jiaming Wei, Junlong Wu, Beihe Wang, Jun Wang, Yao Zhu & Dingwei Ye

  3. Department of Pathology, Fudan University Shanghai Cancer Center, No.270 at Dong’an Road, Xuhui District, Shanghai, 200032, People’s Republic of China

    Hualei Gan

  4. Department of Urology, Huashan Hospital, Fudan University, No.12 at Middle Wulumuqi Road, Jing’an District, Shanghai, 200040, People’s Republic of China

    Chen Yang

Authors
  1. Shengming Jin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Junjie Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yijun Shen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hualei Gan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Peihang Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yu Wei
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jiaming Wei
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Junlong Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Beihe Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Jun Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Chen Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Yao Zhu
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Dingwei Ye
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Yao Zhu or Dingwei Ye.

Ethics declarations

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.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 16 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jin, S., Wang, J., Shen, Y. et al. Comparison of different lymph node staging schemes in prostate cancer patients with lymph node metastasis. Int Urol Nephrol 52, 87–95 (2020). https://doi.org/10.1007/s11255-019-02294-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11255-019-02294-z

Keywords

Search

Navigation