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Superiority of log odds of positive lymph nodes (LODDS) for prognostic prediction after gastric cancer surgery: a multi-institutional analysis of 7620 patients in China

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Abstract

Purpose

To compare the 8th pN system with ratio-based and Log odds of positive lymph nodes (LODDS) staging systems for predicting the overall survival (OS) of gastric cancer (GC) patients after curative gastric resection.

Methods

We analyzed, retrospectively, clinicopathologic and prognostic data from three Chinese medical centers, on 7620 patients who underwent curative surgery for GC. We established a hypothetical tumor-LODDS-metastasis (TLM) and tumor-ratio-metastasis (TRM) staging system. The relative discriminative abilities of the different staging systems were assessed using Akaike’s Information Criterion (AIC), a linear trend chi-square test, and a likelihood ratio chi-square test.

Results

The cut-off points of the LODDS were set as: ≤ − 1.5, − 1.5 to − 1.0, − 1.0 to − 0.5, − 0.5 to 0, and > 0. There were significant differences in the survival of patients in different LODDS classifications for each pN or LNR group. When stratified by the LODDS classification, the prognosis was more homologous according to the pN or lymph-node ratio (LNR) classifications. The modified TLM staging system had better discriminatory ability and better optimistic prognostic stratification than the 8th TNM or the TRM staging systems for predicting the prognosis of patients with GC.

Conclusions

The LODDS staging system was superior to other lymph-node classifications for predicting the prognosis of patients undergoing gastrectomy GC. LODDS may be incorporated into a GC staging system if these results are confirmed by other studies.

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References

  1. Sasako M, Saka M, Fukagawa T, Katai H, Sano T. Surgical treatment of advanced gastric cancer: Japanese perspective. Dig Surg. 2007;24(2):101–7.

    CAS  PubMed  Google Scholar 

  2. Hartgrink HH, Jansen EP, van Grieken NC, van de Velde CJ. Gastric cancer. Lancet. 2009;374(9688):477–90.

    PubMed  PubMed Central  Google Scholar 

  3. Posteraro B, Persiani R, Dall'Armi V, Biondi A, Arzani D, Sicoli F, et al. Prognostic factors and outcomes in Italian patients undergoing curative gastric cancer surgery. Eur J Surg Oncol. 2014;40(3):345–51.

    CAS  PubMed  Google Scholar 

  4. Sano T, Coit DG, Kim HH, Roviello F, Kassab P, Wittekind C, et al. Proposal of a new stage grouping of gastric cancer for TNM classification: International Gastric Cancer Association staging project. Gastric Cancer. 2017;20(2):217–25.

    PubMed  Google Scholar 

  5. Coburn NG, Swallow CJ, Kiss A, Law C. Significant regional variation in adequacy of lymph node assessment and survival in gastric cancer. Cancer. 2006;107(9):2143–51.

    PubMed  Google Scholar 

  6. Estes NC, MacDonald JS, Touijer K, Benedetti J, Jacobson J. Inadequate documentation and resection for gastric cancer in the United States: a preliminary report. Am Surg. 1998;64(7):680–5.

    CAS  PubMed  Google Scholar 

  7. Schwarz RE, Smith DD. Clinical impact of lymphadenectomy extent in resectable gastric cancer of advanced stage. Ann Surg Oncol. 2007;14(2):317–28.

    PubMed  Google Scholar 

  8. Smith DD, Schwarz 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(28):7114–24.

    PubMed  Google Scholar 

  9. Deng J, Liu J, Wang W, Sun Z, Wang Z, Zhou Z, et al. Validation of clinical significance of examined lymph node count for accurate prognostic evaluation of gastric cancer for the eighth edition of the American Joint Committee on Cancer (AJCC) TNM staging system. Chin J Cancer Res. 2018;30(5):477–91.

    PubMed  PubMed Central  Google Scholar 

  10. Wang J, Hassett JM, Dayton MT, Kulaylat MN. The prognostic superiority of log odds of positive lymph nodes in stage III colon cancer. J Gastrointest Surg. 2008;12(10):1790–6.

    PubMed  Google Scholar 

  11. 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.

    PubMed  Google Scholar 

  12. Coimbra FJ, Costa WL Jr, Montagnini AL, Diniz AL, Ribeiro HS, Silva MJ, et al. The interaction between N-category and N-ratio as a new tool to improve lymph node metastasis staging in gastric cancer: results of a single cancer center in Brazil. Eur J Surg Oncol. 2011;37(1):47–544.

    CAS  PubMed  Google Scholar 

  13. Kunisaki C, Shimada H, Nomura M, Matsuda G, Otsuka Y, Ono H, et al. Clinical impact of metastatic lymph node ratio in advanced gastric cancer. Anticancer Res. 2005;25(2B):1369–75.

    PubMed  Google Scholar 

  14. Marchet A, Mocellin S, Ambrosi A, Morgagni P, Garcea D, Marrelli D, et al. 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.

    PubMed  PubMed Central  Google Scholar 

  15. Chen S, Zhao BW, Li YF, Feng XY, Sun XW, Li W, et al. The prognostic value of harvested lymph nodes and the metastatic lymph node ratio for gastric cancer patients: results of a study of 1,101 patients. PLoS ONE. 2012;7(11):e49424.

    CAS  PubMed  PubMed Central  Google Scholar 

  16. 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(3):478–85.

    PubMed  Google Scholar 

  17. Wang W, Xu DZ, Li YF, Guan YX, Sun XW, Chen YB, et al. Tumor-ratio-metastasis staging system as an alternative to the 7th edition UICC TNM system in gastric cancer after D2 resection--results of a single-institution study of 1343 Chinese patients. Ann Oncol. 2011;22(9):2049–56.

    CAS  PubMed  Google Scholar 

  18. Sun Z, Xu Y, de Li M, 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(11):2571–80.

    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.

    CAS  PubMed  PubMed Central  Google Scholar 

  20. Aurello P, Petrucciani N, Nigri GR, La Torre M, Magistri P, Tierno S, et al. Log odds of positive lymph nodes (LODDS): what are their role in the prognostic assessment of gastric adenocarcinoma? J Gastrointest Surg. 2014;18(7):1254–60.

    PubMed  Google Scholar 

  21. Calero A, Escrig-Sos J, Mingol F, Arroyo A, Martinez-Ramos D, de Juan M, et al. Usefulness of the log odds of positive lymph nodes to predict and discriminate prognosis in gastric carcinomas. J Gastrointest Surg. 2015;19(5):813–20.

    CAS  PubMed  Google Scholar 

  22. 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):505–14.

    CAS  PubMed  Google Scholar 

  23. Ueno S, Tanabe G, Sako K, Hiwaki T, Hokotate H, Fukukura Y, et al. Discrimination value of the new western prognostic system (CLIP score) for hepatocellular carcinoma in 662 Japanese patients. Cancer of the Liver Italian Program. Hepatology. 2001;34(3):529–34.

    CAS  PubMed  Google Scholar 

  24. Cho YK, Chung JW, Kim JK, Ahn YS, Kim MY, Park YO, et al. Comparison of 7 staging systems for patients with hepatocellular carcinoma undergoing transarterial chemoembolization. Cancer. 2008;112(2):352–61.

    CAS  PubMed  Google Scholar 

  25. Kee KM, Wang JH, Lee CM, Chen CL, Changchien CS, Hu TH, et al. Validation of clinical AJCC/UICC TNM staging system for hepatocellular carcinoma: analysis of 5,613 cases from a medical center in southern Taiwan. Int J Cancer. 2007;120(12):2650–5.

    CAS  PubMed  Google Scholar 

  26. Yoon HM, Ryu KW, Nam BH, Cho SJ, Park SR, Lee JY, et al. Is the new seventh AJCC/UICC staging system appropriate for patients with gastric cancer? J Am Coll Surg. 2012;214(1):88–96.

    PubMed  Google Scholar 

  27. Shen JY, Kim S, Cheong JH, Kim YI, Hyung WJ, Choi WH, et al. The impact of total retrieved lymph nodes on staging and survival of patients with pT3 gastric cancer. Cancer. 2007;110(4):745–51.

    PubMed  Google Scholar 

  28. Bouvier AM, Haas O, Piard F, Roignot P, 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(11):2862–6.

    PubMed  Google Scholar 

  29. 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):1408–12.

    CAS  PubMed  Google Scholar 

  30. 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):330–3.

    PubMed  Google Scholar 

  31. Sun Z, Zhu GL, Lu C, Guo PT, Huang BJ, Li K, et al. The impact of N-ratio in minimizing stage migration phenomenon in gastric cancer patients with insufficient number or level of lymph node retrieved: results from a Chinese mono-institutional study in 2159 patients. Ann Oncol. 2009;20(5):897–905.

    CAS  PubMed  Google Scholar 

  32. Celen O, Yildirim E, Berberoglu U. Prognostic impact of positive lymph node ratio in gastric carcinoma. J Surg Oncol. 2007;96(2):95–101.

    PubMed  Google Scholar 

  33. Lee SY, Hwang I, Park YS, Gardner J, Ro JY. Metastatic lymph node ratio in advanced gastric carcinoma: a better prognostic factor than number of metastatic lymph nodes? Int J Oncol. 2010;36(6):1461–7.

    PubMed  Google Scholar 

  34. Wang X, Wan F, Pan J, Yu GZ, Chen Y, Wang JJ. Prognostic value of the ratio of metastatic lymph nodes in gastric cancer: an analysis based on a Chinese population. J Surg Oncol. 2009;99(6):329–34.

    PubMed  Google Scholar 

  35. Spolverato G, Ejaz A, Kim Y, Squires MH, Poultsides G, Fields RC, et al. Prognostic performance of different lymph node staging systems after curative intent resection for gastric adenocarcinoma. Ann Surg. 2015;262(6):991–8.

    PubMed  Google Scholar 

  36. Feinstein AR, Sosin DM, Wells CK. The Will Rogers phenomenon. Stage migration and new diagnostic techniques as a source of misleading statistics for survival in cancer. N Engl J Med. 1985;312(25):1604–8.

    CAS  PubMed  Google Scholar 

  37. Songun I, Putter H, Kranenbarg EM, Sasako M, van de Velde CJ. Surgical treatment of gastric cancer: 15-year follow-up results of the randomised nationwide Dutch D1D2 trial. Lancet Oncol. 2010;11(5):439–49.

    PubMed  Google Scholar 

  38. Wu SG, Sun JY, Yang LC, Zhou J, Li FY, Li Q, et al. Prognosis of patients with esophageal squamous cell carcinoma after esophagectomy using the log odds of positive lymph nodes. Oncotarget. 2015;6(34):36911–22.

    PubMed  PubMed Central  Google Scholar 

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Acknowledgements

This study was supported in part by grants from the Programs of National Natural Science Foundation of China (Nos. 81572372, 81172080, 81201773, 81572372), National Key Research and Development Program (MOST-2016YFC1303202), National Precision Medicine Research Program (2017YFC0908304) and the National Key Clinical Specialist Construction Programs of China (2013-544).

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Author notes

  1. Pengfei Gu, Jingyu Deng, Zhe Sun, Zhenning Wang and Wei Wang contributed equally to this work.

Authors and Affiliations

  1. Department of Gastric Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Cancer for Cancer, Tianjin, 300060, China

    Pengfei Gu, Jingyu Deng & Han Liang

  2. Department of Surgical Oncology, The First Affiliated Hospital of China Medical University, Shenyang, 110001, China

    Zhe Sun, Zhenning Wang & Huimian Xu

  3. Department of Gastric and Pancreatic Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China

    Wei Wang & Zhiwei Zhou

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  1. Pengfei Gu
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Correspondence to Jingyu Deng, Han Liang, Huimian Xu or Zhiwei Zhou.

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Gu, P., Deng, J., Sun, Z. et al. Superiority of log odds of positive lymph nodes (LODDS) for prognostic prediction after gastric cancer surgery: a multi-institutional analysis of 7620 patients in China. Surg Today 51, 101–110 (2021). https://doi.org/10.1007/s00595-020-02091-7

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