title: Prognostic value of three different lymph node staging systems in the survival of patients with gastric cancer following D2 lymphadenectomy.
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.
authors.affiliation: Division of Gastrointestinal Surgery Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China.|Gastric Cancer Center, Sun Yat-sen University, Guangzhou, 510080, China.
authors.forename: Chen
authors.initials: C
authors.lastname: Jian-Hui
authors.affiliation: Division of Gastrointestinal Surgery Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China.|Gastric Cancer Center, Sun Yat-sen University, Guangzhou, 510080, China.
authors.forename: Cai
authors.initials: C
authors.lastname: Shi-Rong
authors.affiliation: Division of Gastrointestinal Surgery Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China.|Gastric Cancer Center, Sun Yat-sen University, Guangzhou, 510080, China.
authors.forename: Wu
authors.initials: W
authors.lastname: Hui
authors.affiliation: Division of Gastrointestinal Surgery Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China.|Gastric Cancer Center, Sun Yat-sen University, Guangzhou, 510080, China.
authors.forename: Chen
authors.initials: C
authors.lastname: Si-le
authors.affiliation: Division of Gastrointestinal Surgery Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China.|Gastric Cancer Center, Sun Yat-sen University, Guangzhou, 510080, China.
authors.forename: Xu
authors.initials: X
authors.lastname: Jian-Bo
authors.affiliation: Division of Gastrointestinal Surgery Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China.|Gastric Cancer Center, Sun Yat-sen University, Guangzhou, 510080, China.
authors.forename: Zhai
authors.initials: Z
authors.lastname: Er-Tao
authors.affiliation: Division of Gastrointestinal Surgery Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China.|Gastric Cancer Center, Sun Yat-sen University, Guangzhou, 510080, China.
authors.forename: Chen
authors.initials: C
authors.lastname: Chuang-Qi
authors.affiliation: Division of Gastrointestinal Surgery Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China. YLH@medmail.com.cn.|Gastric Cancer Center, Sun Yat-sen University, Guangzhou, 510080, China. YLH@medmail.com.cn.
authors.forename: He
authors.initials: H
authors.lastname: Yu-Long
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D011379:Prognosis; D016016:Proportional Hazards Models; D012372:ROC Curve; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D055815:Young Adult
keywords: Gastric cancer; Log odds of positive lymph nodes; Lymph node ratio; Nodal system; Prognosis