Log Odds of Positive Lymph Nodes (Lodds) As an Independent Predictor of Overall Survival Following Radical Cystectomy in Urothelial Bladder Cancer: Time to Rethink Conventional Node Staging Publisher Pubmed



Salari A¹ ; Ghahari M¹ ; Nowroozi A¹ ; Ghahari P¹ ; Haddad M¹ ; Sahebi L¹ ; Ayati M¹ ; Momeni SA¹ ; Nowroozi MR¹ ; Amini E¹
Source: Clinical Genitourinary Cancer Published:2023

Abstract

Background: Radical cystectomy (RC) with lymph node dissection is the mainstay of treatment for patients with muscle-invasive bladder cancer (MIBC) and high risk non-MIBC. The American Joint Committee on Cancer's (AJCC) node staging and lymph node ratio (LNR) systems are used in estimating prognosis; however, they do not directly factor in negative dissected nodes. In this study, we evaluated the log odds of positive lymph nodes (LODDS), a novel measure of nodal involvement, as a predictor of survival. Patients and methods: Eighty-three patients who underwent RC were retrospectively included and their demographic and clinical data were collected. Kaplan-Meier curve and Cox regression were used for survival analyses. Results: Median number of dissected lymph nodes was 13 (range 3-45). ROC curve analysis indicated −0.92 as the optimal LODDS cutoff. LODDS > −0.92 was associated with higher T stage, lymphovascular invasion, and significantly worse overall survival (OS) (mean OS 18.6 vs. 45.1 months, P-value < .001). Furthermore, we evaluated AJCC node staging, LNR, and LODDS in three separate multivariable Cox regression models. Among 3 different measures of nodal disease burden, only LODDS was an independent predictor of OS (HR 2.71, 95% CI 1.28-5.73, P = .009). Conclusions: Our results show that LODDS is an independent predictor of OS and outperforms AJCC node staging and LNR in forecasting prognosis among patients with urothelial bladder cancer who undergo RC. © 2022 Elsevier Inc.