Evaluating log odds of positive lymph nodes as a prognostic tool in differentiated gastric cancer: A retrospective study

Abstract

BACKGROUND The log odds of positive lymph nodes (LODDS) are correlated with survival outcomes in gastric cancer (GC) patients. However, the prognostic value across different tumor differentiation levels remains unclear. AIM To evaluate the independent prognostic value of LODDS and the stratified predictive efficacy in GC patients with different histologic differentiations. METHODS We conducted a retrospective analysis of 2103 GC patients who underwent radical gastrectomy at Zhejiang Cancer Hospital. The prognostic value of LODDS was compared with that of other lymph node-based metrics, including the pathologic N stage, number of positive lymph nodes, number of total lymph nodes, and lymph node ratio, stratified by tumor differentiation. RESULTS LODDS was identified as an independent prognostic factor for overall survival in moderately to poorly differentiated GC patients. LODDS demonstrated superior predictive accuracy over other lymph node metrics. A nomogram incorporating LODDS, age, carbohydrate antigen (CA) 125, carcinoembryonic antigen, and tumor differentiation showed good predictive accuracy (C-index = 0.703). A higher LODDS was significantly associated with an increased risk of recurrence or metastasis, poorly differentiated tumors, advanced cancer, mucinous gastric adenocarcinoma, nerve invasion, and vascular tumor thrombus. Additionally, LODDS was positively correlated with the tumor markers CA19-9, CA72-4, CA125, and CA242 (all P < 0.05). CONCLUSION LODDS is an independent prognostic indicator for patients with moderately and poorly differentiated GC, and its predictive performance is superior to that of other models.