Skip to main content
SpringerLink
Log in

Usefulness of the Log Odds of Positive Lymph Nodes to Predict and Discriminate Prognosis in Gastric Carcinomas

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

The lymph node ratio (LNR) and log odds of positive lymph nodes (LODDS) have been proposed to minimize the stage migration phenomenon. The value of the LODDS and LNR staging systems to predict and discriminate prognosis was assessed and compared to the International Union Against Cancer (UICC) TNM classification (pN).

Methods

Three hundred and twenty-six patients with gastric carcinoma were retrospectively studied. Disease-specific survival rates were calculated for every pN, LNR, and LODDS category.

Results

Four LNR categories (0, 1–25, 26–75, and >76 %) and four LODDS categories (−5 to −3, > −3 to −1, > −1 to 3, and >3 to 5) were established. In the multivariate analysis, only the stage pT3-4 versus pT1-2 (HR 1.88, 95 % CI 1.11–3.20, p = 0.02) and LODDS as continuous variable (HR 1.40, 95 % CI 1.21–1.61, p < 0.001) remained as independent prognostic factors. In patients with <16 lymph nodes retrieved, only the LODDS system could discriminate different disease-specific survival curves for every category. LODDS categories were able to discriminate subgroups with different prognoses in pN stages and LNR categories.

Conclusions

The LODDS staging system was superior to the pN classification and LNR system to discriminate risk prognosis especially in patients with an insufficient number of retrieved lymph nodes.

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

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

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. Maruyama K, Gunven P, Okabayashi K, Sasako M, Kinoshita T. Lymph node metastases of gastric cancer. General pattern in 1931 patients. Ann Surg 1989; 210 (5): 596–602

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  2. Siewert JR, Bottcher K, Stein HJ, Roder JD. Relevant prognostic factors in gastric cancer. Ten-year results of the German Gastric Cancer Study. Ann Surg 1998; Vol. 228 (4), 449–461

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  3. Kim JP. Surgical Results in Gastric Cancer Semin Surg Oncol 1999; 17:132–138

    Article  CAS  PubMed  Google Scholar 

  4. Cuschieri A, Weeden S, Fielding J J Bancewicz, J Craven, V Joypaul, et al. Patient survival after D1 and D2 resections for gastric cancer: long-term results of the MCR randomized surgical trial. Br J Cancer 1999; 79:1522–1530

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  5. Bonenkamp JJ, Hermans J, Sasako M, van de Velde CJH, et al. Extended lymph-node dissection for gastric cancer. N Engl J Med 1999; 340: 908–914

    Article  CAS  PubMed  Google Scholar 

  6. van Cutsem, Dicato M, Geva R, Arber N, Bang Y, Bernson A, et al. The diagnosis and management of gastric cancer: expert discussion and recommendations from the 12th ESMO/World Congress on Gastrointestinal Cancer, Barcelona, 2010. Ann Oncol 2011; 22 (Suppl 5): 1–9

    Article  Google Scholar 

  7. Gastric Cancer. NCCN Clinical Practice Guidelines in Oncology. V1.2013. www.nccn.org

  8. Sobin LH, Gospodarowicz MK, Wittekind C (2009) TNM classification of malignant tumours, 7th edn. Wiley-Blackwell, New York: pp 73–77

    Google Scholar 

  9. Mullaney PJ, Wadley MS, Hyde C, Wyatt J, Lawrence G, Hallissey MT, et al. Appraisal of compliance with the UICC/AJCC staging system in the staging of gastric cancer. Br J Surg 2002; 89: 1405–1408.

    Article  CAS  PubMed  Google Scholar 

  10. Bouvier AM, Haas O, Piard F, Roignot Ph, Bonithon-Kopp C, Faivre J. How many nodes must be examined to accurately stage gastric carcinomas? Results from a population based study. Cancer 2002; 94: 2862–2866.

    Article  PubMed  Google Scholar 

  11. Smith DD, Schwartz RR, Schwarz RE. Impact of total lymph node count on staging and survival after gastrectomy for gastric cancer: Data from a large US-population database. J Clin Oncol 2005; 23:7114–7124.

    Article  PubMed  Google Scholar 

  12. Dubecz A, Solymosi N, Schweigert M, Stadlhuber RJ, Peters JH, Ofner D, et al. Time trends and disparities in lymphadenectomy for gastrointestinal cancer in the United States: a population-based analysis of 326,243 patients. J Gastrointest Surg 2013; 17(4):611–619

    Article  CAS  PubMed  Google Scholar 

  13. Inoue K, Nakane Y, Iiyama H, Sato M, Kanbara T, Nakai K, et al. The superiority of ratio-based lymph node staging in gastric carcinoma. Ann Surg Oncol 2002; 9(1):27–34.

    Article  PubMed  Google Scholar 

  14. Nitti D, Marchet A, Olivieri M, Ambrosi A, Mencarelli R, Belluco C et al. Ratio between metastatic and examined lymph nodes is an independent prognostic factor after D2 resection for gastric cancer: analysis of a large European monoinstitutional experience. Ann Surg Oncol 2003; 10: 1077–1085.

    Article  PubMed  Google Scholar 

  15. Rodriguez Santiago JM, Munoz E, Marti M, Quintana S, Veloso E, Marco C. Metastatic lymph node ratio as a prognostic factor in gastric cancer. Eur J Surg Oncol 2005; 31:59–66.

    Article  CAS  PubMed  Google Scholar 

  16. Marchet A, Mocellin S, Ambrosi A, Morgagni P, Garcea D, Marrelli D. 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 2007; 245(4): 543–52

    Article  PubMed Central  PubMed  Google Scholar 

  17. Wang J, Dang P, Raut CP, Pandalai PK, Maduekwe UN, Rattner DW, et al. Comparison of a lymph node ratio–based staging system with the 7th AJCC system for gastric cancer. Analysis of 18,043 patients from the SEER database. Ann Surg 2012; 255:478–485

    Article  PubMed  Google Scholar 

  18. Sun Z, Xu Y, Li DM, Wang ZN, Zhu GL, Huang BJ, et al. Log Odds of positive lymph nodes. A novel prognostic indicator superior to the number-based and the ratio-based N category for gastric cancer patients with R0 resection. Cancer 2010; 116:2571–2580

    Article  PubMed  Google Scholar 

  19. Qiu MZ, Qiu HJ, Wang ZQ, Ren C, Wang DS, Zhang DS, et al. The Tumor-Log Odds of Positive Lymph Nodes-Metastasis Staging System, a Promising New Staging System for Gastric Cancer after D2 Resection in China. PLoS One 2012; 7(2):e31736. doi: 10.1371/journal.pone.0031736

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  20. Wang X, Appleby DH, Zhang X, Gan L, Wang JJ, Wan F. Comparison of three lymph node staging schemes for predicting outcome in patients with gastric cancer. Br J Surg 2013; 100(4):505–514

    Article  CAS  PubMed  Google Scholar 

  21. Xu J, Bian Y, Jin X, Cao H. Prognostic assessment of different metastatic lymph node staging methods for gastric cancer after D2 resection. World J Gastroenterol 2013; 19(12): 1975–1983

    Article  PubMed Central  PubMed  Google Scholar 

  22. Liu H, Deng J, Zhang R, Hao X, Jiao X, Liang H. The RML of lymph node metastasis was superior to the LODDS for evaluating the prognosis of gastric cancer. Int J Surg 2013; 11: 419–424

    Article  PubMed  Google Scholar 

  23. Smith DD, Nelson RA, Schwarz RE. A comparison of five competing lymph node staging schemes in a cohort of resectable gastric cancer patients. Ann Surg Oncol 2014; 21 (3): 875–882.

    Article  PubMed  Google Scholar 

  24. Roder JD, Bottcher K, Busch R, Wittekind C, Hermanek P, Siewert JR. Classification of regional lymph node metastasis from gastric carcinoma. German Gastric Cancer Study Group. Cancer 1998; 82: 621–631.

    CAS  Google Scholar 

  25. Lee HK, Yang HK, Kim WH, Lee KU, Choe KJ, Kim JP. Influence of the number of lymph nodes examined on staging of gastric cancer. Br J Surg 2001; 88(10):1408–1412.

    Article  CAS  PubMed  Google Scholar 

  26. Seevaratnam R, Bocicariu A, Cardoso R, Yohanathan L, Dixon M, Law C, et al. How many lymph nodes should be assessed in patients with gastric cancer? A systematic review. Gastric Cancer 2012; 15 (Suppl 1):S70–S88

    Article  PubMed  Google Scholar 

  27. Martinez-Ramos D, A. Calero, J. Escrig-Sos, Mingol F, Daroca-Jose JM, Sauri M, Arroyo A, et al. Prognosis for gastric carcinomas with an insufficient number of examined negative lymph nodes Eur J Surg Oncol 2014; 40(3): 358–365.

    Article  CAS  PubMed  Google Scholar 

  28. Ichikura T, Ogawa T, Chochi K, Kawabata T, Sugasawa H, Mochizuki H. Minimum number of lymph nodes that should be examined for the International Union Against Cancer/American Joint Committee on Cancer TNM classification of gastric carcinoma. World J Surg. 2003; 27(3):330–333

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of General and Digestive Surgery, Hospital General Universitario, Cami de l’Almazara 11, 03203, Elche, Spain

    A. Calero, A. Arroyo, R. Calpena & F. J. Lacueva

  2. Department of General and Digestive Surgery, Hospital General Universitario, Castelló de la Plana, Castellon, Spain

    J. Escrig-Sos, D. Martinez-Ramos & J. L. Salvador-Sanchis

  3. Department of General and Digestive Surgery, Hospital Universitario y Politecnico La Fe, Valencia, Spain

    F. Mingol, M. de Juan & E. Garcia-Granero

Authors
  1. A. Calero
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. Escrig-Sos
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. F. Mingol
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. Arroyo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. D. Martinez-Ramos
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. M. de Juan
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. J. L. Salvador-Sanchis
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. E. Garcia-Granero
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. R. Calpena
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. F. J. Lacueva
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. Calero.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Calero, A., Escrig-Sos, J., Mingol, F. et al. Usefulness of the Log Odds of Positive Lymph Nodes to Predict and Discriminate Prognosis in Gastric Carcinomas. J Gastrointest Surg 19, 813–820 (2015). https://doi.org/10.1007/s11605-014-2728-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-014-2728-5

Keywords

Search

Navigation