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.
Keywords
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Article info
Publication history
Published online: December 06, 2022
Accepted:
December 4,
2022
Received in revised form:
December 3,
2022
Received:
April 7,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Elsevier Inc. All rights reserved.
