The Prognostic Superiority of Log Odds of Positive Lymph Nodes in Stage III Colon Cancer

• Published in: Journal of gastrointestinal surgery Vol. 12; no. 10; pp. 1790 - 1796
• Main Authors: Wang, Jiping, Hassett, James M., Dayton, Merril T., Kulaylat, Mahmoud N.
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01-10-2008; Springer Nature B.V
• Subjects: 2008 Ssat Plenary Presentation; Aged; Aged, 80 and over; Colon; Colonic Neoplasms - mortality; Colonic Neoplasms - pathology; Colorectal cancer; Confidence intervals; Female; Gastroenterology; Humans; Lymph Nodes - pathology; Male; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Staging; Prognosis; Proportional Hazards Models; Retrospective Studies; SEER Program; Surgery; Survival Analysis; United States; United States; Colon cancer; Staging; Lymph node ratio; Log odds
• DOI: 10.1007/s11605-008-0651-3
• EISSN: 1873-4626
• ISSN: 1091-255X

Background
Literature showed that lymph node ratio (LNR) and total number of lymph nodes (TNODS) are independent prognostic factors in node-positive colon cancer. Our study assesses the prognostic superiority of the log odds of positive lymph nodes (LODDS) in the same patient population.
Material and Methods
A total of 24,477 stage III colon cancer cases from the SEER registry were reviewed. Patients were categorized based on LNR into LNR1 to LNR4, according to cutoff points 0.07, 0.25, and 0.50, and based on LODDS into LODDS1 to LODDS5, according to cutoff points −2.2, −1.1, 0, and 1.1. The relative risk (RR), and 95% confidence interval (CI) were evaluated using the method of Kaplan–Meier and Cox model.
Results
Patients with LNR4 could be classified into LODDS4 (61.4%) and LODDS5 (38.4%). The survival in these two groups was significantly different (5-year survival, 33.5% vs. 23.3%,
p
 < 0.0001). Univariate analysis showed that the higher LNR (RR = 3.45, 95% CI = 3.26–3.66) or low TNODS (RR = 0.99, 95% CI = 0.986–0.99) was significantly associated with poor survival. However, after adjusting for LODDS status, the association did not appear to be significant (LNR, RR = 0.90, 95% CI = 0.65–1.24,
p
 = 0.52; TNODS, RR = 1.001, 95% CI = 0.997–1.005,
p
 = 0.54).
Conclusion
Colon cancer patients with LNR4 disease represent a heterogeneous group. The previously reported prognostic association of TNODS and LNR and outcome of stage III disease were confounded by LODDS.