Login to Access Video or Poster Abstract: MP21-17
Sources of Funding: None

Introduction

Prior studies reported a novel prognostic indicator - log odds of positive lymph nodes (LODDS) might be superior to the number of lymph node metastases (LNMs) and positive lymph node density (LND) for prediction of prognosis in several gastrointestinal malignancies. Our aim was to, for the first time, evaluate the prognostic significance of LODDS in muscle-invasive bladder cancer (MIBC) and compare the performance to LNM and LND.

Methods

Patients with non-metastatic MIBC (T2-4N0-3M0) who underwent radical cystectomy (RC) were identified from the Surveillance, Epidemiology, and End Results (SEER) database. The primary outcome was cancer-specific survival (CSS). Univariable and multivariable Cox regression models with LNM, LND, or LODDS were analyzed. Multivariable models controlled for age, race, sex, grade, and T-stage. The prognostic performance of the models was assessed with Harrell&[prime]s concordance index (C-index) and Akaike&[prime]s Information Criterion (AIC).

Results

We identified 3,882 patients, 2,712 (69.9%) without LNM and 1,170 (20.1%) with LNM. Multivariable Cox models showed that increased LNM (HR = 1.057, 95% CI = 1.047-1.067, P < 0.001), increased LND (HR = 4.627, 95% CI = 3.836-5.582, P < 0.001), and increased LODDS (HR = 1.328, 95% CI = 1.286-1.373, P < 0.001) were all associated with decreased CSS. In multivariable regression the LODDS (C-index = 0.715; AIC = 21,239) was superior to LNM (C-index = 0.697; AIC = 21,410) and LND (C-index = 0.712; AIC =21,295). All the performance outcomes in each model before and after stratified with number of LNs removed are shown in Table 1. Scatter plots created to evaluate the relationship between LNM, LND, and LODDS are shown in Figure 1. For patients with LND scores of 0 or 1, LND can be stratified by LODDS.

Conclusions

LODDS appears to be a promising predictor of CSS in patients with MIBC following RC, especially those with an insufficient number of LNs removed. It could serve as an important adjunction to the traditional TNM and LND classification.

Funding

None