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

• Published in: Clinical genitourinary cancer 2023-06, Vol.21 (3), p.e175-e181
• Main Authors: Salari, Abolfazl, Ghahari, Mohammadreza, Nowroozi, Ali, Ghahari, Parichehr, Haddad, Mojtaba, Sahebi, Leyla, Ayati, Mohsen, Momeni, Seyed Ali, Nowroozi, Mohammad Reza, Amini, Erfan
• Format: Article
• Language: English
• Subjects: Bladder neoplasms; Carcinoma, Transitional Cell - pathology; Carcinoma, Transitional Cell - surgery; Cystectomy; Humans; Kaplan-Meier Estimate; Lymph Node Ratio; Lymph Nodes - pathology; Lymph Nodes - surgery; Lymphatic Metastasis - pathology; Neoadjuvant Chemotherapy; Neoplasm Staging; Nodal involvement; Prognosis; Retrospective Studies; Urinary Bladder Neoplasms - pathology; Urinary Bladder Neoplasms - surgery
• ISSN: 1558-7673; 1938-0682
• DOI: 10.1016/j.clgc.2022.12.001

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. 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. 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). 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. We evaluated log odds of positive lymph nodes (LODDS) as a prognostic marker in patients who underwent radical cystectomy with lymph node dissection. We found that LODDS is an independent predictor of overall survival and is superior to other measures of lymph node burden including lymph node ratio and conventional node staging.