Comparison of Different Lymph Node Staging Schemes for Predicting Survival Outcomes in Node-Positive Endometrioid Endometrial Cancer Patients

Abstract

Objective: To compare the prognostic predictive performance of six lymph node (LN) staging schemes: American Joint Committee on Cancer (AJCC) N stage, number of retrieved lymph nodes (NRLN), number of positive lymph nodes (NPLN), number of negative lymph nodes (NNLN), lymph node ratio (LNR), and log odds of positive lymph nodes (LODDS) among node-positive endometrioid endometrial cancer (EEC) patients.Methods: A total of 3,533 patients diagnosed with node-positive EEC between 2010 and 2016 from the Surveillance, Epidemiology, and End Results (SEER) database were retrospectively analyzed. We applied X-tile software to identify the optimal cutoff value for different staging schemes. Univariate and multivariate Cox regression models were used to assess the relationships between different LN schemes and survival outcomes [disease-specific survival (DSS) and overall survival (OS)]. Moreover, Akaike information criterion (AIC) and Harrell concordance index (C-index) were used to evaluate the predictive performance of each scheme in both continuous and categorical patterns.Results: N stage (N1/N2) was not an independent prognostic factor for node-positive EEC patients based on multivariate analysis (DSS: p = 0.235; OS: p = 0.145). Multivariate model incorporating LNR demonstrated the most superior goodness of fit regardless of continuous or categorical pattern. Regarding discrimination power of the models, LNR outperformed other models in categorical pattern (OS: C-index = 0.735; DSS: C-index = 0.737); however, LODDS obtained the highest C-index in continuous pattern (OS: 0.736; DSS: 0.739).Conclusions: N stage (N1/N2) was unable to differentiate the prognosis for node-positive EEC patients in our study. However, LNR and LODDS schemes seemed to have a better predictive performance for these patients than other number-based LN schemes whether in DSS or OS, which revealed that LNR and LODDS should be more helpful in prognosis assessment for node-positive EEC patients than AJCC N stage.

Prognostic model for the exemption of adjuvant chemotherapy in stage IIIC endometrial cancer patients

“…We chose age, race, grade, histology, T stage, tumor size, and LODDS from the univariate Cox analysis (all p < 0.05). Surprisingly or not, 09 FIGO stage was not able to discern the patients with optimal overall survival from those who had not ( p = 0.062), which was in accordance with the previous studies ( 9 , 13 , 14 , 16 , 18 ). Multivariate analysis was sequentially performed to identify the age, grade, T stage, tumor size, and LODDS as the independent risk factors for the survival outcomes in stage IIIC EC patients with ART alone ( Table 2 ).…”

“…It is noteworthy that rare pathological histology type was not included in this study, and we presented the histology type as type I (endometrioid cancer and adenocarcinoma) and type II consisting of serous cancer, carcinosarcoma, and clear cell cancer. The log odds of positive lymph nodes (LODDS), defined as log e [(number of positive LN + 0.5)/(number of negative LN + 0.5)], was calculated to represent the LN status given that our previous studies have demonstrated that LODDS was the optimal LN index to predict the survival probability for EC patients with LN metastases ( 13 , 14 ). X-tile software (version 3.6.1; Yale University, New Haven, CT, USA) was used to identify the best cutoff values for continuous variables including age, tumor size, and LODDS given the inconsistency of these cutoff values from previous research ( 8 , 15 – 18 ).…”

Prognostic nomogram for predicting the overall survival rate of patients with uterine clear‐cell carcinoma: Based on SEER database

“…evaluated the efficacy of six schemes in predicting the survival after endometrioid endometrial cancer: LODDS, AJCC N staging, the number of lymph nodes examined, the number of positive lymph nodes, the number of negative lymph nodes, and the lymph node ratio. The results demonstrated that LODDS was superior in prognostic assessment compared with AJCC N staging 27 . Currently, there are no studies that have used LODDS to predict the survival rate of endometrial clear‐cell carcinoma.…”

“…Both the number of positive and negative lymph nodes are considered as evaluation metrics in LODDS, which has been demonstrated to be effective at predicting cancer prognosis in multiple studies. 7,25,26 For instance, Yang et al 27 evaluated the efficacy of six schemes in predicting the survival after endometrioid endometrial cancer: LODDS, AJCC N staging, the number of lymph nodes examined, the number of positive lymph nodes, the number of negative lymph nodes, and the lymph node ratio. The results demonstrated that LODDS was superior in prognostic assessment compared with AJCC N staging.…”

“…The results demonstrated that LODDS was superior in prognostic assessment compared with AJCC N staging. 27 Currently, there are no studies that have used LODDS to predict the survival rate of endometrial clear-cell carcinoma. Therefore, LODDS was also fully considered in the present study, which revealed that it is also an independent predictor for UCCC.…”