title: Comparison of three lymph node classifications for survival prediction in distant metastatic gastric cancer.
abstract: BACKGROUND
  The optimal lymph node (LN) classification system for prognostic assessment in distant metastatic gastric cancer (DMGC) patients who undergo LN dissection remains unclear. Therefore, we compared the prognostic performance of positive LN (PLN), LN ratio (LNR), and log odds of positive LNs (LODDS) in DMGC patients.
  
  
  METHODS
  A total of 1999 DMGC patients who underwent lymphadenectomy recorded in the Surveillance Epidemiology and End Results database from 2004 to 2012 were reviewed.
  
  
  RESULTS
  Univariate analyses showed that the PLN, LNR and LODDS systems were all significantly correlated with cancer-specific survival (CSS). However, only the LODDS classification remained an independent prognostic factor through the multivariate analysis. Furthermore, this classification could efficiently discriminate survival outcomes in patients within the same positive PLN category, as well as in patients with no positive node involvement. Both the LODDS and LNR classifications had better discriminatory ability, monotonicity, and homogeneity of prognostic stratification, as well as more accurate 1 or 2-year CSS prediction, than the PLN classification. The performances of the LNR and LODDS classifications were similar. Additionally, we found that inclusion of PORT carried a survival benefit across all LODDS intervals except the "LODDS ≤ -1.0" subgroup.
  
  
  CONCLUSIONS
  Our findings indicate that the LODDS classification is the most optimal system for prognostic assessment in DMGC patients. Incorporating LODDS into the staging system of DMGC patients will enable clinicians to more accurately predict prognosis and guide regional therapy regimen decisions in DMGC patients.
authors.affiliation: Department of Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
authors.forename: Rui
authors.initials: R
authors.lastname: Zhou
authors.affiliation: Department of Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
authors.forename: Jingwen
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Department of Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
authors.forename: Huiying
authors.initials: H
authors.lastname: Sun
authors.affiliation: Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
authors.forename: Yulin
authors.initials: Y
authors.lastname: Liao
authors.affiliation: Department of Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China. Electronic address: nfyyliaowj@163.com.
authors.forename: Wangjun
authors.initials: W
authors.lastname: Liao
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology* / Q000556:secondary / Q000601:surgery; D000368:Aged; D016208:Databases, Factual; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D015999:Multivariate Analysis; D009367:Neoplasm Staging / Q000145:classification*; D011379:Prognosis; D012189:Retrospective Studies; D018426:SEER Program; D013274:Stomach Neoplasms / Q000473:pathology* / Q000556:secondary / Q000601:surgery; D014481:United States
keywords: Cancer-specific survival; Distant metastatic gastric cancer; Log odds of positive lymph nodes; Prognosis; Registry analysis