Number Of Negative Nodes Research Articles

A Modified N Stage Method Considering Negative Lymph Node and Positive Lymph Node for Esophagus Cancer Evaluation

The N stage of esophagus cancer (EC) should be related to the number of positive lymph node (PLN) and the number of negative lymph node (NLN), and both of them had been demonstrated as independent prognostic factors recently. The information of 13,491 patients with EC was reviewed based on the database of SEER. The parameters related to prognosis were investigated by using univariate and multivariate analysis in a Cox proportional hazard regression model. A modified N stage method was proposed based on the re-adjust ratio of the number of PLN to the number of NLN according to the result of a Cox proportional hazard model, and it was evaluated by applying the Cross Validation method to the training and validation cohort. The superiority of the modified N stage method was explored by comparing it to the N stage in 7th AJCC based on the ROC analysis. Age, race, tumor length, tumor site, AJCC tumor stage, tumor differentiation, the combination of treatment, and organ or distant metastasis were all significant prognostic factors. The hazard rate (HR) of the number of PLN on prognosis was 1.042, while the HR of the number of NLN was 0.968. The re-adjust ratio of the number of PLN to the number of NLN was determined by the relative impact. The cut-off number of the re-adjust ratio was investigated from a series of survival analysis. The modified patient's N staging was defined as below: N1stage: the ratio range was from 0 to 0.21, N2: 0.22 ∼ 0.48, N3: more than 0.49. The performance of this modified N stage method was evaluated and its superiority compared to the N stage coming from AJCC was identified. The modified N stage method based on the re-adjust ratio of the number of PLN to the number of NLN could improve the evaluation of the tumor N stage.

The association of metastasis-related indexes of lymph nodes and the prognosis of stage N2b colorectal cancer patients

Objective: To evaluate the prognostic value of lymph node metastasis-related indexes in patients with stage N2b colorectal cancer. Methods: Clinicopathologic data of 245 patients with stage N2b colorectal cancer who initially underwent radical operation in Cancer Hospital, Chinese Academy of Medical Sciences between January 2007 and December 2012 were retrospectively analyzed. The prognostic values of several indexes, including number of positive lymph nodes, number of negative lymph nodes, lymph node ratio (LNR) and log odds of positive lymph nodes (LODDS) were analyzed. Results: The 5-year overall survival rate of 245 patients with colorectal cancer was 54.0%, and the 5-year recurrence-free survival rate was 48.5%.Univariate analysis showed that perineural or blood vessel invasion, T stage, postoperative adjuvant therapy, number of positive lymph nodes, number of negative lymph nodes, LNR, and LODDS were significantly associated with the 5-year overall survival of colorectal cancer patients (P<0.05). Multivariate cox regression analysis showed that, number of positive lymph nodes, number of negative lymph nodes, LNR, LODDS were all independent prognostic factors for stage N2b colorectal cancer patients (P<0.05). The areas under the receiver operating characteristic curve (ROC) curves of number of positive lymph node, number of negative lymph nodes, LNR and LODDS were 0.649, 0.667, 0.690 and 0.683, respectively, however, no statistical significance was observed between the number of negative lymph nodes (P=0.622), LNR (P=0.178) or LODDS (P=0.272) and the number of positive lymph nodes. Conclusion: The number of positive lymph nodes, number of negative lymph nodes, LNR and LODDS were all independent prognostic factors for patients with stage N2b colorectal cancer.

Prognostic value of the number of negative lymph nodes in esophageal carcinoma without lymphatic metastasis.

BackgroundThe impact of the number of negative lymph nodes (LNs) on survival in patients with esophageal cancer remains a controversial issue. This study investigated the association between the number of resected LNs and the prognosis of patients with node‐negative esophageal carcinoma.MethodsA retrospective review was performed of the data of 429 patients who underwent esophagectomy with modern two‐field lymphadenectomy for the treatment of esophageal cancer between January 1998 and December 2008. Histopathology showed no LN involvement in the patient sample. The prognostic impact of the number of negative LNs and the clinicopathological factors were analyzed.ResultsThe overall median survival time and the one, three, and five‐year overall survival rates were 63.0 months and 78.5%, 64.0%, and 51.2%, respectively. Survival analysis confirmed that the number of negative LNs and the depth of tumor invasion were independent prognostic factors. Patients with a high number of negative LNs had a better overall survival rate than patients with a low number of negative LNs (P < 0.001). Patients with dissected LNs > 14 for pT1 tumors (P < 0.001) and > 19 for pT2–3 tumors (P < 0.001 and P = 0.001, respectively) had better long‐term survival outcomes.ConclusionsThe number of negative LNs is an independent prognostic factor for node‐negative esophageal carcinoma. Extended LN dissection is recommended to improve the survival of patients with node‐negative esophageal carcinoma.

An increased number of negative lymph nodes is associated with a higher immune response and longer survival in colon cancer patients.

BackgroundThe purpose of the present study was to examine the relationship among the number of negative lymph nodes (LNs), the local and systemic immune response, and survival in patients with colon cancer.Patients and methodsOne thousand one hundred and fifty-seven patients with colon cancer who underwent surgery at Sun Yat-sen University Cancer Center between 2009 and 2014 were included. We examined negative LNs in relation to the local and systemic immune response, including percentage carcinoma, neutrophil and lymphocyte infiltration, Crohn’s-like reaction, neutrophil to lymphocyte ratio, platelets, and C-reactive protein (CRP). Disease-free survival and overall survival were also examined. We performed subgroup analysis based on the distribution of negative LNs.ResultsAn increased number of negative LNs was associated with greater neutrophil invasion (p=0.001), more lymphocyte invasion (p=0.001), and more Crohn’s-like reaction (p=0.001). No significant correlation was observed between negative LNs and the neutrophil to lymphocyte ratio. More than 12 negative LNs were associated with increased platelets and CRP levels. A higher number of negative LNs was independently associated with longer disease-free survival in stage I+II patients (p=0.004) and stage III patients (p=0.015), while negative LNs were also independent prognostic factors in stage IV patients (p=0.007).ConclusionOur study suggests that negative LNs are indicators of the immune response and are associated with a better prognosis in patients with colon cancer.

The impact of log odds of positive lymph nodes (LODDS) in colon and rectal cancer patient stratification: a single-center analysis of 323 patients.

Log odds of positive nodes (LODDS), defined as the log of the ratio between the number of positive nodes and the number of negative nodes, has been recently introduced as a tool in predicting prognosis. This study aims to establish the effective and prognostic value of LODDS in predicting the survival outcome of CRC patients undergoing surgical resection. The study population is represented by 323 consecutive patients with primary colon or rectal adenocarcinoma thatunderwent curative resection. LODDS values were calculated by empirical logistic formula, log(pnod+0.5)/(tnod-pnod+0.5). It was defined as the log of the ratio between the number of positive nodes and the number of negative nodes. The patients were divided into three groups: LODDS0 (≤-1.36), LODDS1 (>-1.36≤-0.53) and LODDS2 (>-0.53). Kaplan-Meier curve analyses showed 3-year OS rates of the patients staged by LODDS classification. These values were 88.3, 74.8 and 61.8% for LODDS0, LODDS1 and LODDS2, respectively (P≤0.001). In a multivariate analysis, LODDS is an independent prognostic factor of 3-year OS. This is in contrast to pN stage and lymph node ratio, which shows no statistical significance. ROC analyses showed that LODDS predicted OS better than lymph node ratio. LODDS classification has a better prognostic effect than pN stage and lymph node ratio. LODDS offers a finer stratification and accurately predicts survival of CRC patients.

A Prognostic Nomogram for Cervical Cancer after Surgery from SEER Database.

Background: To develop and validate a nomogram based on the conventional measurements and log of odds between the number of positive lymph node and the number of negative lymph node (LODDS) in predicting prognosis for cervical cancer patients after surgery.Methods: A total of 8202 cervical cancer patients with pathologically confirmed between 2004 and 2014 were obtained from the Surveillance, Epidemiology, and End Results (SEER) database. All the patients were divided into training (n=3603) and validation (n=4599) cohorts based on consecutive age of diagnosis. Demographic and clinical pathological factors were evaluated the association with overall survival (OS). Parameters significantly correlating with OS were used to create a nomogram. An independent external validation cohort was subsequently used to assess the predictive performance of the model.Results: In the training set, age at diagnosis, race, marital status, tumor grade, FIGO stage, histology, size and LODDS were correlated significantly with outcome and used to develop a nomogram. The calibration curve for probability of survival showed excellent agreement between prediction by nomogram and actual observation in the training cohort, with a bootstrap-corrected concordance index of 0.749(95% CI, 0.731-0.767). Importantly, our nomogram performed favorably compared to the currently utilized FIGO model, with concordance indices of 0.786 (95% CI, 0.764 to 0.808) vs 0.685 (95%CI, 0.660 to 0.710) for OS in the validation cohort, respectively.Conclusions: By incorporating LODDS, our nomogram may be superior to the currently utilized FIGO staging system in predicting OS in cervical cancer patients after surgery.

223P - The number of negative lymph node within the thoracic cavity is a strong predictor for the extent of lymphadenectomy in patients with esophageal squamous cell carcinoma

223P - The number of negative lymph node within the thoracic cavity is a strong predictor for the extent of lymphadenectomy in patients with esophageal squamous cell carcinoma

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).

PurposeWe aimed to assess prognostic value of metastatic pelvic lymph node (mPLN) in early-stage cervical cancer treated with radical surgery followed by postoperative chemoradiotherapy. Also, we sought to define a high-risk group using prognosticators for recurrence.Materials and MethodsA multicenter retrospective study was conducted using the data from 13 Korean institutions from 2000 to 2010. A total of 249 IB-IIA patients with high-risk factors were included. We evaluated distant metastasis-free survival (DMFS) and disease-free survival (DFS) in relation to clinicopathologic factors including pNstage, number of mPLN, lymph node (LN)ratio (number of positive LN/number of harvested LN), and log odds of mPLNs (log(number of positive LN+0.5/number of negative LN+0.5)).ResultsIn univariate analysis, histology (squamous cell carcinoma [SqCC] vs. others), lymphovascular invasion (LVI), number of mPLNs (≤ 3 vs. > 3), LN ratio (≤ 17% vs. > 17%), and log odds of mPLNs (≤ ‒0.58 vs. > ‒0.58) were significant prognosticators for DMFS and DFS. Resection margin involvement only affected DFS. No significant survival difference was observed between pN0 patients and patients with 1-3 mPLNs. Multivariate analysis revealed that mPLN > 3, LVI, and non-SqCC were unfavorable index for both DMFS (p < 0.001, p=0.020, and p=0.031, respectively) and DFS (p < 0.001, p=0.017, and p=0.001, respectively). A scoring system using these three factors predicts risk of recurrence with relatively high concordance index (DMFS, 0.69; DFS, 0.71).ConclusionmPLN > 3 in early-stage cervical cancer affects DMFS and DFS. A scoring system using mPLNs > 3, LVI, and non-SqCC could stratify risk groups of recurrence in surgically resected early-stage cervix cancer with high-risk factors.

Does it matter that lymphadenectomy through right or left side thoracotomy during esophagectomy?

Lymph node metastasis is one of the critical determinants in the prognosis of esophageal cancer. Many lymph node-associated parameters, such as regional or nonregional location (1,2), number of positive nodes (3-6), number of total harvested nodes (7), ratio of positive to total nodes (5,6,8), and even number of negative nodes (9), have been reported to have prognostic relevance. There are also abundant studies assessing the diagnostic and therapeutic value of lymphadenectomy (10,11). The diagnostic purpose of lymphadenectomy is to identify the presence of lymphatic spread, which can be a surrogate of systemic disease. Although lymph node dissection itself may not have a survival benefit, the adjuvant treatments for lymph node metastasis are expected to. However, if viable malignant cells initially nest in lymph nodes and gradually spread to systemic metastases, lymphadenectomy would be an opportunity to cure patients, especially those with early phase of lymphatic dissemination.

Prognostic value of number of negative lymph node in patients with stage II and IIIa non-small cell lung cancer.

BackgroundThe definitive validation evidence of the implications of lymph node metastases regarding the survival of Non-Small Cell Lung Cancer (NSCLC) patients is lacking. We aimed to evaluate the prognostic impact of several lymph node metastases-associated risk factors including Number of Negative Lymph Node (NLN) and risk-stratify NSCLC patients into subsets with different prognosis.MethodA total of 482 patients with N1 and N2 NSCLC were included in this study. The prognostic importance of a set of risk factors was examined by univariate and multivariate analysis. The cut-off points and 5 years survival rates were calculated to test the best grouping system to stratify the patients with difference outcome.ResultsOur analysis indicated that both Ratio of the Metastatic Lymph nodes (RML) and Number of Negative Lymph Node (NLN) were associated with overall survival (OS) and disease free survival (DFS). RML percentage 20% and 55%, and NLN counts 10 and 30 were proved as the optimal cut-off points to predict OS by classifying patients into 3 groups, respectively. RML and NLN actually are more powerful in predicting survival outcome for male patients compared to female patients. Stratified survival analyses using combined factors indicated that the 5-year survival rate (5-YSR) is high in RML I + NLN I/III subgroup (5-YSR = 57.1% and 43.3%) and low in RML III + NLN II/III subgroup (5-YSR = 0.0 % each).ConclusionsNLN is a strong prognostic factor for OS and DFS of stage II/IIIa NSCLC patients, and provides a useful classification scheme for NSCLC patients when combined with RML.

Re-evaluating the prognostic validity of the negative to positive lymph node ratio in node-positive gastric cancer patients

Lymph node status is one of the most important clinical outcome determinants in gastric cancer patients. Categorization based on the metastatic node count alone, however, would presumably be influenced by the extent of lymphadenectomy and the stage migration phenomenon. We statistically analyzed relevant clinicopathologic data of 351 gastric cancer patients with node metastasis who had undergone R0 surgery to compare the reliability of the negative to positive lymph nodes ratio to those of other classifications of lymph node metastasis for predicting outcomes. Survival analyses demonstrated the negative to positive lymph nodes ratio to be an independent predictor of overall survival in the 351 gastric cancer patients (hazard ratio=0.414; P<.001) and revealed significant superiority (P<.001) for evaluating overall survival based on direct comparison with other categories of lymph node metastasis applying case-control matching. In addition, the negative to positive lymph nodes ratio was found to correlate significantly with the number of negative lymph nodes (P<.001), pN stage (P<.001), and the positive to dissected lymph nodes ratio (P<.001) by multinomial logistic regression analysis. Finally, the interplay effect analyses revealed the negative to positive lymph nodes ratio to yield information similar to that provided by the positive to dissected lymph nodes ratio (R2=1.000), while providing more information on both the number of dissected lymph nodes and the number of negative lymph nodes than the positive to dissected lymph nodes ratio. The negative to positive lymph nodes ratio, which reflects comprehensive information on dissected, positive, and negative node counts, appears to be a useful alternative for predicting the outcomes of node-positive gastric cancer patients.

Better survival in PMRT of female breast cancer patients with >5 negative lymph nodes: A population-based study.

Many studies have confirmed the role of postmastectomy radiotherapy (PMRT) for breast cancer patients with at least 4 lymph nodes invasion in the postoperative therapy. Recently, the number of negative lymph nodes (NLNs) has been increasingly paid attention to and recognized as a prognostic indicator in different kinds of caners. Therefore, it is very necessary to study the association between the number of NLNs and the prognosis of PMRT in breast cancer patients. In our study, we used Surveillance, Epidemiology, and End Results (SEER) population-based data and identified 16,686 breast cancer patients to explore their correlation. The ROC curve and the log-rank χ test were applied to determine the appropriate cutoff point of the number of NLNs and 5 was selected as the cutoff point. Furthermore, the cutoff point 5 was validated as an independent prognostic factor affecting cancer-specific survival (CSS) and overall survival (OS) in breast cancer patients, as confirmed by both univariate and multivariate analysis (P < 0.001). In addition, subgroup analysis showed that the number of NLNs >5 can be a prognostic indicator in patients with PMRT according to different clinical variables (all, P < 0.001). Importantly, our results showed that PMRT obviously improved CSS and OS in patients regardless of the number of NLNs (P < 0.001). In conclusion, our study showed the number of NLNs is an independent prognostic factor for breast cancer patients with PMRT, and those who have higher number of NLNs have an increased CSS and OS.

A novel nomogram based on LODDS to predict the prognosis of epithelial ovarian cancer

BACKGROUNDTo develop and validate a nomogram based on log of odds between the number of positive lymph node and the number of negative lymph node (LODDS) in predicting the overall survival (OS) and cancer specific survival (CSS) for epithelial ovarian cancer (EOC) patients.MATERIALS AND METHODSA total of 10,692 post-operative EOC patients diagnosed between 2004 and 2013 were obtained from the Surveillance, Epidemiology, and End Results (SEER) database and randomly divided into training (n = 7,021) and validation (n = 3,671) cohorts. Multiple clinical pathological parameters were assessed and compared with outcomes. Parameters significantly correlating with outcomes were used to build a nomogram. Bootstrap validation was subsequently used to assess the predictive value of the model.RESULTSIn the training set, age at diagnosis, race, marital status, tumor location, stage, grade and LODDS were correlated significantly with outcome in both the univariate and multivariate analyses and were used to develop a nomogram. The nomogram demonstrated good accuracy in predicting OS and CSS, with a bootstrap-corrected concordance index of 0.757 (95% CI, 0.746-0.768) for OS and 0.770 (95% CI, 0.759-0.782) for CSS. Notably, in this population our model performed favorably compared to the currently utilized Federation of Gynecology and Obstetrics (FIGO) model, with concordance indices of 0.699 (95% CI, 0.688-0.710, P < 0.05) and 0.719 (95% CI, 0.709- 0.730, P < 0.05) for OS and CSS, respectively. Using our nomogram in the validation cohort, the C-indices were 0.757 (95% CI, 0.741-0.773, P < 0.05, compared to FIGO) for OS and 0.762 (95% CI, 0.746-0.779, P < 0.05, compared to FIGO) for CSS.CONCLUSIONSLODDS works as an independent prognostic factor for predicting survival in patients with EOC regardless of the tumor stage. By incorporating LODDS, our nomogram may be superior to the currently utilized FIGO staging system in predicting OS and CSS among post-operative EOC patients.

544P The number of negative lymph node was an indicator on the extent of lymphadenectomy in middle thoracic esophageal squamous cell carcinoma

544P The number of negative lymph node was an indicator on the extent of lymphadenectomy in middle thoracic esophageal squamous cell carcinoma

Improving overall survival with post-mastectomy radiotherapy in a group of early-stage breast cancer: the number of negative lymph nodes sufficient to eliminate post-mastectomy radiotherapy

The role of post-mastectomy radiotherapy (PMRT) in the management of node-negative T1-T2 tumors remains unclear. Clinical decision-making is more complex when suboptimal numbers of nodes are examined. The minimum number of negative nodes required in omitting PMRT in these patients is unknown. This is a retrospective study of patients with T1-T2, node-negative tumors who had undergone modified radical mastectomy (MRM). Analyzed were the potential prognostic factors and the variables of taking chemotherapy, hormone therapy, PMRT, as well as the number of examined nodes in different cutoffs, from 0 to 9 nodes. Five hundred and three eligible patients were studied. The median follow-up was 60 months. The only prognostic factor was the variable of ≤3 vs. >3 nodes (P = 0.01). Other variables did not have a significant effect on the outcome. Analysis showed that without PMRT, the 5 and 10-year overall survival (OS) of 44 patients with ≤3 examined nodes were 76 and 63 %, respectively, and the 5- and 10-year OS rates of 155 patients with >3 examined nodes were 89 and 3 examined nodes were 92 and 88 %, respectively (P = 0.056). According to the results of the current study on node-negative T1-T2 breast cancer patients, PMRT can overcome the inferior outcome of a suboptimal dissection and improve OS and is therefore recommended as a cutoff point if less than 4 nodes have been examined.

Number of negative lymph nodes as a prognostic factor in esophageal squamous cell carcinoma.

The aim of this study is to investigate the number of negative lymph nodes (NLNs) as a prognostic factor for survival in patients with resected esophageal squamous cell carcinoma. A total of 381 esophageal squamous cell carcinoma patients who had underwent surgical resection as the primary treatment was enrolled into this retrospective study. The impact of number of NLNs on patient's overall survival was assessed and compared with the factors among the current tumor-nodes-metastasis (TNM) staging system. The number of NLNs was closely related to the overall survival, and the 5-year survival rate was 45.4% for number of NLNs of >20 (142 cases) and 26.4% for NLNs ≤ 20 (239 cases) (P = 0.001). In multivariate survival analysis, the number of NLNs remained an independent prognostic factor (P = 0.002) as did the other current TNM factors. For subgroup analysis, the predictive value of number of NLNs was significant in patients with T3 or T4 disease (P = 0.001) and patients with N1 and N2-3 disease (P = 0.025, 0.043), but not in patients with T1 or T2 disease or patients with N0 disease. The number of NLNs, which represents the extent of lymphadenectomy for esophageal squamous cell carcinoma, could impact the overall survival of patients with resected esophageal squamous cell carcinoma, especially among those with nodal-positive disease and advanced T-stage tumor.

Increased number of negative lymph nodes is associated with improved survival outcome in node positive gastric cancer following radical gastrectomy

The concept of negative lymph node (NLN) counts has recently attracted attention as a prognostic indicator in various cancer. However, the correlation between NLN counts and patient prognosis in the setting of gastric cancer is not fully studied. Surveillance, Epidemiology, and End Results Program (SEER)-registered gastric cancer patients were used for analysis in this study. Clinicopathological characteristics, including race, age, gender, and tumor stage, grade, and cause specific survival were collected. Univariate and multivariate Cox proportional hazards model were used to assess the risk factors for survival. As results, X-tile plots identified 3 and 9 as the optimal cutoff value to divide the patients into high, middle and low risk subsets in terms of cause specific survival, and NLN was validated as independently prognostic factor in mulivariate Cox analysis (P < 0.001). Further analysis showed that NLN was a prognosis factor in each N stage. Collectively, our study results firmly demonstrated that the number of NLNs was an independent prognostic factor for gastric cancer patients, and together with the N stage, it could provide more accurate prognostic information than the N stage alone.

Prognostic significance of the number of dissected lymph nodes in Siewert type Ⅱadenocarcinoma of the esophagogastric junction without lymphatic metastasis

To investigate the correlation between the number of dissected lymph nodes (LNs) and the prognosis of patients with node-negative Siewert type ⅡAEG. 248 patients with Siewert type Ⅱ AEG treated in our hospital between January 1998 and December 2008 were retrospectively assessed. All cases underwent left transthoracic subtotal esophagogastrectomy with conventional two-field lymphadenectomy, and were histopathologically proved to be without lymph node involvement. The prognostic impact of the number of dissected LNs was analyzed. The overall median survival time and the 1-, 3-, and 5-year overall survival rates were 64 months, 80.4%, 60.8% and 51.0%, respectively. Cox regression showed that the number of dissected LNs and the depth of tumor invasion were independent prognostic factors. Patients with a high number of negative LNs had better overall survival than patients with a low number of negative LNs (P<0.05). The patients had better long-term survival outcomes with more than 10 LN dissected for cases with pT1 tumor (P<0.001), and so did those with more than 15 LN dissected for cases with pT2-3 tumor (P=0.003, 0.018, respectively). The number of negative lymph nodes and the depth of tumor invasion are independent prognostic factors for node-negative Siewert type Ⅱ AEG, and adequate lymph node dissection can improve the long-term survival.

Prognostic value of three different lymph node staging systems in the survival of patients with gastric cancer following D2 lymphadenectomy.

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.

Number of negative lymph nodes as a prognostic factor for ypN0-N1 breast cancer patients undergoing neoadjuvant chemotherapy.

Some of node-positive patients could have a pathologically complete response in terms of lymph nodes. For these patients, the number of negative lymph nodes (NLNs) may be higher than that in the same-stage patients who initially received mastectomy. After neoadjuvant chemotherapy (NAC), the following treatment especially the postmastectomy radiotherapy (PMRT) is controversial for ypN1 (with one to three positive lymph nodes after NAC) patients. A total of 289 patients who received NAC from 2006 to 2009 were included in the investigation. The prognostic value of the number of NLNs on these patients was analyzed. Besides, we analyzed if the number of NLNs would give some indications on PMRT in ypN1 patients. The follow-up of all the patients began the first chemotherapy on 15 March 2015. The 5-year disease-free survival (DFS) and overall survival (OS) rates were determined as 67.2 and 81.1%, respectively. The number of NLNs was associated with primary stage (p < 0.001), pathological tumor size (p < 0.05), pathological nodal stage (p < 0.001), and pathological stage after NAC (p < 0.001). The univariate and multivariate analyses revealed that the number of NLNs is an independent prognostic factor in both DFS and OS. In ypN0-N1 stage, patients with >13 NLNs had better DFS (p < 0.001) and OS (p < 0.001) than the patients with ≤13 NLNs. Although the fact patients in ypN2-N3 stage with >13 NLNs had better DFS and OS than the others, there were no significant statistical difference. In the subgroup analysis, PMRT improved the OS (p < 0.05) and DFS (p < 0.05) of ypN1 patients with ≤13 NLNs. The number of NLNs is a prognostic indicator in ypN0-N1 patients. Patients in ypN1 stage with less number of NLNs will benefit from PMRT.