Number of Positive Lymph Nodes Is Superior to LNR and LODDS for Predicting the Prognosis of Pancreatic Neuroendocrine Neoplasms

Gao, Bo; Zhou, Dongkai; Qian, Xiaohui; Jiang, Yiqun; Liu, Zhenghao; Zhang, Wang; Wang, Weilin

doi:10.3389/fendo.2021.613755

Cited by 13 publications

(19 citation statements)

References 24 publications

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“…When all lymph nodes examined were positive, the LNR value did not increase with the number of positive lymph nodes. When all lymph nodes examined were negative, LODDS values decreased with increasing number of negative lymph nodes (13). LODDS has unique value for risk stratification of node-negative patients, which is not available with LNR and 8th AJCC N staging systems (19).…”

Section: Discussionmentioning

confidence: 99%

“…Log odds of positive lymph node (LODDS) use pathological nodal data to stratify patients for differences in survival, and LODDS can help clinicians identify high-risk patients regardless of whether they are node-positive or not (8). The 8th edition AJCC N staging system, LNR and LODDS three lymph node staging systems are gradually applied in pancreatic and bile duct cancers (8,13). However, there are no studies explore and compare the value of these lymph node staging systems in predicting the survival of ACs, and cannot provide a reference for lymph node staging in patients with ACs.…”

Section: Introductionmentioning

confidence: 99%

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Comparing the predictive performance of different lymph node staging systems for postoperative overall survival in patients with ampullary carcinoma

Chen²,

Li³

2023

Front. Surg.

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AimThis study was to analyze and compare the predictive performance of the 7th and the 8th edition American Joint Committee on Cancer (AJCC) N staging system, lymph nodes ratio (LNR) and log odds of positive lymph node (LODDS) for the survival of patients with ampullary carcinomas (ACs).MethodThis retrospective cohort study included patients with primary ACs after surgery from the Surveillance, Epidemiology, and End Results (SEER) 2004–2015. Univariate and multivariate Cox proportional hazard models were used. The study population was divided into a training set and a testing set in a ratio of 7–3. The C-index and area under the curve (AUC) were used to compare the predictive performance of the four staging on overall survival (OS) in the training set and the testing set.ResultsA total of 7,480 patients with primary ACs (1,178 survived and 1,128 dead) were in this study. The average follow-up time was 41.1 months. N1 stage and N2 stage of the 8th edition AJCC N staging system, LNR staging (0–0.3), LNR (>0.3), LODDS (−2.4 to −0.8) and LODDS (>−0.8) were associated with OS in AC patients after adjusting for age, race, pT stage, tumor size, grade, radiation, and insurance. The C-index of the 7th AJCC N staging was significantly lower than the C-index of the 8th AJCC N staging in the training set [0.608 vs. 0.629, P < 0.001] and testing set [0.635 vs. 0.658, P < 0.001]. The C-index of the LODDS staging was significantly higher than the C-index of the 8th AJCC N staging in the training set [0.641 vs. 0.629, P = 0.034] and testing set [0.671 vs. 0.658, P = 0.034]. LODDS staging may be a potential predictor of OS at 6 months [AUC = 0.687], 12 months (AUC = 0.692), and 48 months (AUC = 0.709), and LNR staging (AUC = 0.655) may be a potential predictor of OS at 24 months in AC patients. The predictive ability of LNR staging and LODDS staging were also found in different subgroups.ConclusionThe LNR and LODDS staging systems' predictive performance for OS of AC patients were superior to the 8th edition AJCC N staging system, especially in patients ages ≥65 or with higher tumor grade (grade II and III). The LNR staging and the LODDS staging were potential predictors for 24-month OS, and 6, 12, 24 and 48-month OS, respectively.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparing the predictive performance of different lymph node staging systems for postoperative overall survival in patients with ampullary carcinoma

Chen²,

Li³

2023

Front. Surg.

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“…Traditionally, lymph node status is based on positive lymph nodes (PLNs) regardless of the number of resected lymph nodes (RLNs) ( 17 ). At present, the lymph node ratio (LNR), defined as the ratio between the number of PLNs and RLNs, is increasingly recognized as a powerful prognostic tool for many cancers ( 18 , 19 ). The log odds of positive lymph nodes (LODDS) is the logarithm of the ratio of metastatic lymph nodes to negative lymph nodes (log (PLNs+0.5)/(RLNs-PLNs+0.5)) and can identify patients with highly homologous prognoses.…”

Section: Introductionmentioning

confidence: 99%

“…It also overcomes the shortcoming of the LNR regardless of the number of lymph nodes examined ( 20 ). Recently, LODDS staging was hypothesized to be a better predictor of survival in many cancers compared with LNR and PLN staging ( 18 , 21 ). Previously, LODDS was used to analyze the prognostic role of mesenteric lymph nodes (MLNs) involvements in AOC ( 22 ).…”

Section: Introductionmentioning

confidence: 99%

Relationship Between Neoadjuvant Chemotherapy and Log Odds of Positive Lymph Nodes and Their Prognostic Role in Advanced Ovarian Cancer Patients With Optimal Cytoreductive Surgery

et al. 2022

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PurposeTo analyze the relationship between neoadjuvant chemotherapy (NACT) and log odds of positive lymph nodes (LODDS), as well as their prognostic role in advanced ovarian cancer (AOC) patients with optimal cytoreductive surgery.Patients and MethodsFrom the SEER database during 2010-2016, we identified 1,012 AOC patients with optimal cytoreductive surgery. Univariable and multivariable logistic regression was performed to identify the relationship between NACT and LODDS. Overall survival (OS) and cancer-specific survival (CSS) were assessed using the Kaplan-Meier method and log-rank test. Univariable and multivariable Cox regression was conducted to determine the independent prognostic factors for OS and CSS.ResultsFactors associated with significantly higher NACT odds included older (≥60 years old), married, tumor size ≥ 15 cm, FIGO IV, and LODDS ≤ 0.1. Multivariable Cox regression model confirmed older (≥60 years old), unmarried, separated, divorced, widowed, mucinous histology type, tumor size ≥ 15 cm, and LODDS > 0.1 were correlated with increased risks of OS and CSS. NACT was not an independent prognostic factor for OS and CSS. In the subgroup analyses, LODDS was an independent prognostic factor for OS and CSS in patients with < 75 years old, married, unmarried, FIGO III, and tumor size < 15 cm.ConclusionNACT did not show any survival benefit in AOC patients with optimal cytoreductive surgery, but it may be beneficial in reducing LODDS. Meanwhile, clinicians can use grade of LODDS to predict the prognosis of AOC patients with optimal cytoreductive surgery.

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“…While the N stage system is reproducible, it may reduce the likelihood of stage migration which can misguide treatment practice. Some staging systems have been established, including the Total Number of Lymph Nodes Examined (TNLE), the number of Positive Lymph Nodes (PLN), Lymph Node Ratio (LNR), and Log ODDS of positive nodes (LODDS), in order to accurately describe lymph node status ( 9 , 10 ). However, researchers have attempted to develop alternative lymph node staging systems which more accurately predict survival for patients with a number of different cancers.…”

Section: Introductionmentioning

confidence: 99%

Developing and validating a prognostic nomogram for ovarian clear cell carcinoma patients: A retrospective comparison of lymph node staging schemes with competing risk analysis

Xiu²,

Ma³

et al. 2022

Front. Oncol.

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PurposeLymph node (LN) involvement is a key factor in ovarian clear cell carcinoma (OCCC) although, there several indicators can be used to define prognosis. This study examines the prognostic performances of each indicator for OCCC patients by comparing the number of lymph nodes examined (TNLE), the number of positive lymph nodes (PLN), lymph node ratio (LNR), and log odds of metastatic lymph nodes (LODDS).Methods1,300 OCCC patients who underwent lymphadenectomy between 2004 and 2015 were extracted from the Surveillance Epidemiology and End Results (SEER) database. Primary outcomes were Overall Survival (OS) and the cumulative incidence of Cancer-Specific Survival (CSS). Kaplan–Meier’s and Fine-Gray’s tests were implemented to assess OS and CSS rates. After conducting multivariate analysis, nomograms using OS and CSS were constructed based upon an improved LN system. Each nomograms’ performance was assessed using Receiver Operating Characteristics (ROC) curves, calibration curves, and the C-index which were compared to traditional cancer staging systems.ResultsMultivariate Cox’s regression analysis was used to assess prognostic factors for OS, including age, T stage, M stage, SEER stage, and LODDS. To account for the CSS endpoint, a proportional subdistribution hazard model was implemented which suggested that the T stage, M stage, SEER stage, and LNR are all significant. This enabled us to develop a LODDS-based nomogram for OS and a LNR-based nomogram for CSS. C-indexes for both the OS and CSS nomograms were higher than the traditional American Joint Committee on Cancer (AJCC), 8th edition, staging system. Area Under the Curve (AUC) values for predicting 3- and 5-year OS and CSS between nomograms also highlighted an improvement upon the AJCC staging system. Calibration curves also performed with consistency, which was verified using a validation cohort.ConclusionsLODDS and LNR may be better predictors than N stage, TNLE, and PLNs. For OCCC patients, both the LODDS-based and LNR-based nomograms performed better than the AJCC staging system at predicting OS and CSS. However, further large sample, real-world studies are necessary to validate the assertion.

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Number of Positive Lymph Nodes Is Superior to LNR and LODDS for Predicting the Prognosis of Pancreatic Neuroendocrine Neoplasms

Cited by 13 publications

References 24 publications

Comparing the predictive performance of different lymph node staging systems for postoperative overall survival in patients with ampullary carcinoma

Comparing the predictive performance of different lymph node staging systems for postoperative overall survival in patients with ampullary carcinoma

Relationship Between Neoadjuvant Chemotherapy and Log Odds of Positive Lymph Nodes and Their Prognostic Role in Advanced Ovarian Cancer Patients With Optimal Cytoreductive Surgery

Developing and validating a prognostic nomogram for ovarian clear cell carcinoma patients: A retrospective comparison of lymph node staging schemes with competing risk analysis

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