Abstract
The log odds of positive lymph nodes (LODDS) was defined as the log of the ratio between the number of positive lymph nodes and the number of negative lymph nodes, which is a novel and promising nodal staging system for gastric cancer. Here, we aimed to compare the prognostic effect of pN, lymph node ratio (LNR) and LODDS. The association between overall survival and pN, LNR and LODDS was retrospectively analysed. The discriminatory ability and monotonicity of gradients (linear trend χ 2 score), homogeneity ability (likelihood ratio test) and prognostic stratification ability (Akaike information criterion [AIC] and receiver operating characteristic [ROC] curve) were compared among three lymph node staging systems. The pN, LNR and LODDS were all identified as independent prognostic factors for gastric cancer patients in the multivariate analysis. LODDS showed the best prognostic performance (linear trend χ 2 score 266.743, likelihood ratio χ 2 test score 427.771, AIC value 5670.226, area under the curve (AUC) 0.793), followed by LNR and pN. In patients with different levels of retrieved lymph nodes (≤10, 11–14, 15–25 and >25), LODDS was the most powerful for prognostic prediction and discrimination of the heterogeneity among the subgroups. Significant differences in survival were observed among patients in different LODDS subgroups after being classified according to the pN and LNR classifications. LODDS appears to be a more powerful system for predicting the overall survival of gastric cancer patients, as compared to LNR and pN, and may serve as an alternative nodal staging system for gastric cancer.
Highlights
According to the GLOBOCAN 2012 database, 952,000 new cases of gastric cancer and 723,000 cases of gastric cancerrelated death are reported worldwide, which correspond to the total malignant cases of 8.5 and 10.1 %, respectively
The gastric cancer was located in the lower part of the stomach (44.7 %) in most cases, followed by the upper portion (31.6 %), middle portion (21.7 %) and the entire stomach (2.0 %)
The number-based lymph node staging system of Union for International Cancer Control (UICC) classification was widely used, a principle flaw is that the prognostic accuracy is influenced by the number of total retrieved lymph nodes [8, 9]
Summary
According to the GLOBOCAN 2012 database, 952,000 new cases of gastric cancer and 723,000 cases of gastric cancerrelated death are reported worldwide, which correspond to the total malignant cases of 8.5 and 10.1 %, respectively. Lymph node metastasis is known to be one of the most important prognostic factors for gastric cancer. The lymph node staging system, based on the extent of lymph node metastasis, was abandoned in the latest guideline of the Japanese Gastric Cancer Association (JGCA) [1], the prognostic ability of the lymph node staging system of the Union for International Cancer Control (UICC) remains controversial. Some authors indicated that the latest lymph node classification, as part of UICC staging, is influenced by the number of retrieved lymph nodes [2]. The favourable results obtained from a comparison of survival with the ratio-based lymph node system suggest that this system may serve as an alternative to the traditional one. Some studies indicated that patients with the same LNR staging had different survival outcomes, along with
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