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

doi:10.3748/wjg.v31.i21.107029

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World Journal of Gastroenterology

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1007-9327

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Retrospective Study

World J Gastroenterol. Jun 7, 2025; 31(21): 107029
Published online Jun 7, 2025. doi: 10.3748/wjg.v31.i21.107029

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

Chen Liang, Hai-Dong Liu, Yang-Chan Hu, Guo-Xia Liu, Yan-Hua He, Wei-Xing Wu, Jing-Nan Zhou, Yao-Shu Teng, Ji Jing, Yin Shi, Clive Yik-Sham Chung, Chen-Huan Yu, Yi-An Du, Zu Ye, Xiang-Dong Cheng, Dan Zu, Han-Yi He, Yu-Ke Zhong, Chun-Kai Zhang, Yi-Xing Huang, Qi-Mei Bao, Ken Chen, Ming-Cong Deng

Ming-Cong Deng, Ken Chen, Qi-Mei Bao, Yi-Xing Huang, Chun-Kai Zhang, Yu-Ke Zhong, Han-Yi He, Dan Zu, Chen Liang, Hai-Dong Liu, Yang-Chan Hu, Guo-Xia Liu, Yan-Hua He, Wei-Xing Wu, Jing-Nan Zhou, Ji Jing, Chen-Huan Yu, Yi-An Du, Zu Ye, Xiang-Dong Cheng, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine, Chinese Academy of Sciences, Hangzhou 310022, Zhejiang Province, China

Ming-Cong Deng, Hangzhou Medical College, Hangzhou 310013, Zhejiang Province, China

Ken Chen, The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China

Ken Chen, Yi-Xing Huang, Yao-Shu Teng, Department of Otorhinolaryngology, Affiliated Hangzhou First People’s Hospital, School of Medicine, Westlake University, Hangzhou 310006, Zhejiang Province, China

Yi-Xing Huang, Yin Shi, School of Medicine, Zhejiang University, Hangzhou 310058, Zhejiang Province, China,

Dan Zu, Guo-Xia Liu, School of Life Sciences, Tianjin University, Tianjin 300100, China

Hai-Dong Liu, Yi-An Du, Zu Ye, Xiang-Dong Cheng, Zhejiang Provincial Research Center for Upper Gastrointestinal Tract Cancer, Zhejiang Cancer Hospital, Hangzhou 310022, Zhejiang Province, China

Hai-Dong Liu, Yi-An Du, Zu Ye, Xiang-Dong Cheng, Key Laboratory of Prevention, Diagnosis and Therapy of Upper Gastrointestinal Cancer of Zhejiang Province, Hangzhou 310022, Zhejiang Province, China

Clive Yik-Sham Chung, School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China

Clive Yik-Sham Chung, Department of Pathology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China

Co-corresponding authors: Xiang-Dong Cheng, Zu Ye, Yi-An Du and Chen-Huan Yu.

Author contributions: Deng MC and Chen K wrote the original draft; Deng MC, Chen K, Huang YX, Zhang CK, Zhong YK, Bao QM, Zu D, Liang C, Wu WX, Ten YS, and Liu HD carried out normal analyses, data collation; Deng MC, Chen K, He HY, Hu YC, Liu GX, He YH, Zhou JN, and Jing J made a survey of the manuscript, examining the methodology; Deng MC, Chen K, Shi Y, Chung CYS, Yu CH, Du YA, Ye Z, and Cheng XD conceived and wrote, reviewed, and edited the manuscript; Ye Z and Cheng XD contributed equally to this article, they are the co-corresponding authors of this manuscript; and all authors thoroughly reviewed and endorsed the final manuscript.

Supported by the National Natural Science Foundation of China, No. 82473195 and No. 32370797; the Natural Science Foundation of Zhejiang Province, No. LTGY23H160018; the Zhejiang Medical and Health Science and Technology Program, No. 2024KY789 and No. 2023KY615; the National Research Center for Translational Medicine at Shanghai Program, No. NRCTM(SH)-2025-07; the Beijing Science and Technology Innovation Medical Development Foundation, No. KC2023-JX-0270-07; and the Key Laboratory of Prevention, Diagnosis and Therapy of Upper Gastrointestinal Cancer of Zhejiang Province, No. 2022E10021.

Institutional review board statement: This study was approved by the Medical Ethics Committee of Zhejiang Cancer Hospital, approval No. AF-4.0/34-1.

Informed consent statement: All patients signed informed consent forms. The study was conducted in accordance with the Declaration of Helsinki (as revised in 2013).

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

Data sharing statement: The data that support the findings of this study are available from the corresponding author upon reasonable request.

Corresponding author: Xiang-Dong Cheng, MD, Professor, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine, Chinese Academy of Sciences, No. 1 East Banshan Road, Hangzhou 310022, Zhejiang Province, China. yezuqscx@gmail.com

Received: March 13, 2025
Revised: April 23, 2025
Accepted: May 19, 2025
Published online: June 7, 2025
Processing time: 84 Days and 21 Hours

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.

Keywords: Gastric cancer; Log odds of positive lymph nodes; Tumor differentiation; Tumor marker; Overall survival

Core Tip: This study highlights the log odds of positive lymph nodes (LODDS) as a reliable independent prognostic tool for moderately and poorly differentiated gastric cancer, providing more precise risk stratification than traditional systems such as pathologic N stage. Patients with higher LODDS values, which are associated with more aggressive tumor behavior, may benefit from more frequent follow-ups and intensified treatments. The incorporation of the LODDS into a clinical nomogram is expected to improve individualized survival prediction and the development of therapeutic strategies.