Prognostic Value of Log Odds of Positive Lymph Nodes after Radical Surgery Followed by Adjuvant Treatment in High-Risk Cervical Cancer

Abstract

PurposeThe purpose of this study is to compare the prognostic efficacy of the number and location of positive lymph nodes (LN), LN ratio (LNR), and log odds of positive LNs (LODDs) in high-risk cervical cancer treated with radical surgery and adjuvant treatment.Materials and MethodsFifty high-risk patients who underwent radical hysterectomy and pelvic node dissection followed by adjuvant treatment were analyzed retrospectively. The patients had International Federation of Gynecology and Obstetrics (FIGO) stage IA2-IIB. Upper LN is defined as common iliac or higher LN, and LNR is the ratio of positive LNs to harvested LNs. LODDs is log odds between positive LNs and negative LNs. Radiotherapy was delivered to the whole pelvis with median 50.4 Gy/28 Fx± to the para-aortic regions. Platinum-based chemotherapy was used in most patients (93%). The median follow-up duration was 80 months.ResultsThe 5-year disease-free survival (DFS) rate was 76.1%, and the overall survival (OS) rate was 86.4%. Treatment failure occurred in 11 patients, and distant failure (DF) was the dominant pattern (90.9%). In univariate analysis, significantly lower DFSwas observed in patients with perineural invasion, ≥ 2 LN metastases, LNR ≥ 10%, upper LN metastasis, and ≥ –1.05 LODDs. In multivariate analysis, ≥ –1.05 LODDs was the only significant factor for DFS (p=0.011). Of patients with LODDs ≥ –1.05, 40.9% experienced DF. LODDs was the only significant prognostic factor for OS as well (p=0.006).ConclusionLODDs ≥ –1.05 was the only significant prognostic factor for both DFS and OS. In patients with LODDs ≥ –1.05, intensified chemotherapy might be required, considering the high rate of DF.

The Prognostic Impact of the Number of Metastatic Lymph Nodes and a New Prognostic Scoring System for Recurrence in Early-Stage Cervical Cancer with High Risk Factors: A Multicenter Cohort Study (KROG 15-04)

“…It has been studied actively in rectal and gastric cancers, but not in cervical cancers. Kwon et al [ 12 ] reported the prognostic superiority of LODDs to the number of mPLNs and LNR in a patient group similar to our study, but it was limited due to small number of patients. In the present study, LODDs was a significant prognostic factor in univariate analysis, but lost its significance in multivariate analysis.…”

“…The simplest is counting the number of mPLN, which is intuitive and widely used in other cancers [ 10 , 11 ]. The LN ratio (LNR) which has been developed to reflect the extent of LN resection and the log odds of positive LN (LODDs) which has the advantage of reflecting the number of negative LNs are suggested as prognostic variables related to LN status [ 12 ]. However, those studies were limited in that most of them are single institutional retrospective series and also, included heterogeneous population in terms of tumor stages and treatment characteristics.…”

A Prognostic Nomogram for Cervical Cancer after Surgery from SEER Database

“…Since the nomogram quantifies risk by combining and illustrating the relative importance of various prognostic factors and has been used in clinical oncology assessment. Although LODDS has been described as a predictor of cervical cancer, the nomograms with LODDS to predict the prognosis of cervical cancer after surgery has not been described 25 .…”

Prognostic significance of lymph node ratio in node-positive cervical cancer patients

“…Similarly, Takeda et al [ 12 ] found that when the tumor extended to the common iliac nodes or PANs, the patients’ survival became very poor irrespective of other histological characteristics. Kwon et al [ 13 ] compared the prognostic efficacies of various LN-associated variables, including number, location, LNR, and log odds of positive LNs (LODDs, the log of odds between the numbers of positive and negative LNs). Among the methods used for the assessment of LN status, they proposed that LODD was the most powerful indicator associated with DFS.…”