J Cancer 2019; 10(1):249-256. doi:10.7150/jca.27399 This issue

Research Paper

Log Odds Could Better Predict Survival in Muscle-Invasive Bladder Cancer Patients Compared with pN and Lymph Node Ratio

Shengming Jin1,2*, Beihe Wang1,2*, Yiping Zhu1,2*, Weixing Dai2,3, Peihang Xu1,2, Chen Yang4, Yijun Shen1,2✉, Dingwei Ye1,2✉

1. Department of Urology, Fudan University Shanghai Cancer Center, Shanghai,200032,China
2. Department of Oncology, Shanghai Medical College, Fudan University, Shanghai,200032,China
3. Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
4. Department of Urology, Huashan Hospital, Fudan University, Shanghai, 200040,China
*Authors contributed equally to this work

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Jin S, Wang B, Zhu Y, Dai W, Xu P, Yang C, Shen Y, Ye D. Log Odds Could Better Predict Survival in Muscle-Invasive Bladder Cancer Patients Compared with pN and Lymph Node Ratio. J Cancer 2019; 10(1):249-256. doi:10.7150/jca.27399. Available from https://www.jcancer.org/v10p0249.htm

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Background: The aim of this study was to assess the prognostic value of lymph node-associated variables, pN, lymph node ratio (LNR) and log odds (LODDS), in patients with bladder cancer.

Methods: In the discovery cohort, 3358 patients with muscle-invasive bladder cancer (MIBC) and treated with radical cystectomy were identified from the Surveillance, Epidemiology, and End Results (SEER) database. A total of 173 patients with MIBC who underwent radical cystectomy at Shanghai Cancer Center between 2010 and 2013 were enrolled in the validation cohort. LNR and LODDS were calculated in two cohorts and prognostic value was compared between these two variables.

Results: In the two cohorts, survival differences between LODDS, LNR and pN (from the 7th AJCC TNM system) cohorts were statistically significant. Univariate and multivariate analyses confirmed that LNR and LODDS were independent prognostic factors and LODDS was better at predicting prognosis than pN and LNR for patients with MIBC. Moreover, LODDS had a better discriminative ability and model fit, proven by the highest Harrell's concordance index and lowest AIC among the three variables. Furthermore, scatter plots of pN, LNR and LODDS revealed that several groups of LNR and pN were heterogeneous and could be better stratified by LODDS in terms of prognosis estimation.

Conclusion: LODDS has significant prognostic value for patients with MIBC. Moreover, LODDS is better at predicting prognosis for MIBC patients compared with pN and LNR.

Keywords: bladder cancer, lymph node ratio, log odds, lymph node, prognosis