Advantage of log odds of positive lymph nodes in prognostic evaluation of patients with early-onset colon cancer

doi:10.4240/wjgs.v15.i11.2430

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World Journal of Gastrointestinal Surgery

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

World J Gastrointest Surg. Nov 27, 2023; 15(11): 2430-2444
Published online Nov 27, 2023. doi: 10.4240/wjgs.v15.i11.2430

Table 1 Clinical and pathologic characteristics of patients with early-onset colon cancer in two cohorts

Characteristics	Overall	Training set	Testing set	P value
Characteristics	n = 26922	n = 18845	n = 8077	P value
Age	44.00 (39.00, 47.00)	44.00 (39.00, 47.00)	44.00 (39.00, 47.00)	0.730
LN examined	19.00 (14.00, 27.00)	19.00 (14.00, 27.00)	19.00 (14.00, 27.00)	0.959
LN positive	1.00 (0.00, 4.00)	1.00 (0.00, 4.00)	1.00 (0.00, 4.00)	0.800
LNR	0.03 (0.00, 0.19)	0.03 (0.00, 0.19)	0.03 (0.00, 0.20)	0.851
LODDS	-2.66 (-3.66, -1.29)	-2.66 (-3.61, -1.30)	-2.71 (-3.66, -1.24)	0.881
Survival months	51.00 (21.00, 105.00)	51.00 (21.00, 106.00)	50.00 (21.00, 103.00)	0.169
Gender (%)				0.856
Female	13367 (49.7)	9364 (49.7)	4003 (49.6)
Male	13555 (50.3)	9481 (50.3)	4074 (50.4)
Race (%)				0.898
White	19659 (73.0)	13783 (73.1)	5876 (72.7)
Blake	4050 (15.0)	2829 (15.0)	1221 (15.1)
Others	2985 (11.1)	2073 (11.0)	912 (11.3)
Unknown	228 (0.8)	160 (0.8)	68 (0.8)
Marital status (%)				0.383
Married	15296 (56.8)	10674 (56.6)	4622 (57.2)
Others/unknown	11626 (43.2)	8171 (43.4)	3455 (42.8)
Primary site (%)				0.783
Right colon	13053 (48.5)	9139 (48.5)	3914 (48.5)
Left colon	13342 (49.6)	9330 (49.5)	4012 (49.7)
Large intestine, NOS	527 (2.0)	376 (2.0)	151 (1.9)
Histology (%)				0.995
Adenomas/adenocarcinomas	23406 (86.9)	16384 (86.9)	7022 (86.9)
Cystic/mucinous/serous neoplasms	3324 (12.3)	2326 (12.3)	998 (12.4)
Others	192 (0.7)	135 (0.7)	57 (0.7)
Grade (%)				0.055
Well	2775 (10.3)	1992 (10.6)	783 (9.7)
Moderately	18265 (67.8)	12708 (67.4)	5557 (68.8)
Poorly	5094 (18.9)	3603 (19.1)	1491 (18.5)
Undifferentiated	788 (2.9)	542 (2.9)	246 (3.0)
Stage (%)				0.198
Stage 0	204 (0.8)	136 (0.7)	68 (0.8)
Stage I	3939 (14.6)	2792 (14.8)	1147 (14.2)
Stage II	7360 (27.3)	5103 (27.1)	2257 (27.9)
Stage III	9806 (36.4)	6914 (36.7)	2892 (35.8)
Stage IV	5613 (20.8)	3900 (20.7)	1713 (21.2)
T stage (%)				0.437
T0	210 (0.8)	142 (0.8)	68 (0.8)
T1	2595 (9.6)	1845 (9.8)	750 (9.3)
T2	2801 (10.4)	1985 (10.5)	816 (10.1)
T3	15121 (56.2)	10537 (55.9)	4584 (56.8)
T4	6195 (23.0)	4336 (23.0)	1859 (23.0)
N stage (%)				0.259
N0	12410 (46.1)	8645 (45.9)	3765 (46.6)
N1	7886 (29.3)	5576 (29.6)	2310 (28.6)
N2	6626 (24.6)	4624 (24.5)	2002 (24.8)
M stage (%)				0.351
M0	21309 (79.2)	14945 (79.3)	6364 (78.8)
M1	5613 (20.8)	3900 (20.7)	1713 (21.2)
Size (%)				0.871
< 5 cm	9238 (34.3)	6476 (34.4)	2762 (34.2)
≥ 5 cm	9179 (34.1)	6434 (34.1)	2745 (34.0)
Unknown	8505 (31.6)	5935 (31.5)	2570 (31.8)

LNR: Lymph node ratio; LODDS: Log odds of positive lymph node.

Table 2 Univariate Cox regression analyses for predicting overall survival and cause-specific survival in the training cohort

Characteristics	OS		CSS
Characteristics	HR (95%CI)	P value	HR (95%CI)	P value
Age	1.004 (0.999-1.008)	0.090	1.000 (0.995-1.005)	0.896
Gender	1.096 (1.040-1.156)	0.001^a	1.058 (0.996-1.123)	0.067
Race	1.050 (1.013-1.090)	0.009^a	1.073 (1.030-1.118)	0.001^a
Marital status	1.330 (1.262-1.402)	< 0.001^a	1.282 (1.208-1.362)	< 0.001^a
Primary site	0.926 (0.881-0.974)	0.003^a	0.926 (0.875-0.980)	0.007^a
Histology	1.501 (1.409-1.599)	< 0.001^a	1.498 (1.394-1.609)	< 0.001^a
Grade	1.696 (1.631-1.764)	< 0.001^a	1.774 (1.698-1.853)	< 0.001^a
Stage	3.267 (3.149-3.389)	< 0.001^a	4.102 (3.922-4.290)	< 0.001^a
T stage	2.258 (2.169-2.350)	< 0.001^a	2.566 (2.448-2.690)	< 0.001^a
N stage	2.347 (2.271-2.426)	< 0.001^a	2.653 (2.552-2.757)	< 0.001^a
M stage	7.380 (6.988-7.793)	< 0.001^a	8.790 (8.262-9.351)	< 0.001^a
LN examined	0.989 (0.987-0.991)	< 0.001^a	0.988 (0.985-0.991)	< 0.001^a
LN positive	1.085 (1.082-1.087)	< 0.001^a	1.088 (1.085-1.090)	< 0.001^a
LNR	14.557 (13.403-15.811)	< 0.001^a	17.876 (16.324-19.575)	< 0.001^a
LODDS	1.562 (1.541-1.584)	< 0.001^a	1.630 (1.605-1.656)	< 0.001^a
Size	1.006 (0.970-1.043)	0.759	0.999 (0.959-1.040)	0.955

^aP < 0.05.

OS: Overall survival; CSS: Cause-specific survival; HR: Hazard ratio; CI: Confidence interval; LNR: Lymph node ratio; LODDS: Log odds of positive lymph node.

Table 3 Multivariate Cox regression analyses for predicting overall survival in the training cohort

Characteristics	N-stage		PLN		LNR		LODDS
Characteristics	HR (95%CI)	P value	HR (95%CI)	P value	HR (95%CI)	P value	HR (95%CI)	P value
Gender	1.131 (1.073-1.193)	< 0.001^a	1.103 (1.046-1.164)	< 0.001^a	1.120 (1.062-1.181)	< 0.001^a	1.120 (1.062-1.181)	< 0.001^a
Race	1.046 (1.008-1.086)	0.017^a	1.058 (1.020-1.098)	0.003^a	1.048 (1.010-1.088)	0.013^a	1.045 (1.007-1.085)	0.019^a
Marital status	1.300 (1.233-1.371)	< 0.001^a	1.289 (1.223-1.360)	< 0.001^a	1.307 (1.239-1.378)	< 0.001^a	1.310 (1.243-1.382)	< 0.001^a
Primary site	0.901 (0.856-0.948)	< 0.001^a	0.934 (0.888-0.983)	0.008^a	0.891 (0.847-0.938)	< 0.001^a	0.873 (0.830-0.919)	< 0.001^a
Histology	1.184 (1.108-1.264)	< 0.001^a	1.089 (1.019-1.164)	0.012^a	1.120 (1.048-1.197)	0.001^a	1.125 (1.052-1.202)	0.001^a
Grade	1.256 (1.205-1.309)	< 0.001^a	1.284 (1.232-1.338)	< 0.001^a	1.238 (1.188-1.290)	< 0.001^a	1.230 (1.180-1.281)	< 0.001^a
T-stage	1.433 (1.373-1.495)	< 0.001^a	1.485 (1.425-1.549)	< 0.001^a	1.456 (1.396-1.518)	< 0.001^a	1.439 (1.380-1.501)	< 0.001^a
M-stage	4.645 (4.378-4.928)	< 0.001^a	5.074 (4.783-5.382)	< 0.001^a	4.484 (4.220-4.764)	< 0.001^a	4.254 (4.003-4.519)	< 0.001^a
N-stage	1.636 (1.578-1.697)	< 0.001^a	/	/	/	/	/	/
PLN	/	/	1.048 (1.044-1.052)	< 0.001^a	/	/	/	/
LNR	/	/	/	/	4.736 (4.303-5.213)	< 0.001^a	/	/
LODDS	/	/	/	/	/	/	1.309 (1.288-1.330)	< 0.001^a

^aP < 0.05.

HR: Hazard ratio; CI: Confidence interval; PLN: Positive lymph node; LNR: Lymph node ratio; LODDS: Log odds of positive lymph node.

Table 4 Multivariate Cox regression analyses for predicting cause-specific survival in the training cohort

Characteristics	N-stage		PLN		LNR		LODDS
Characteristics	HR (95%CI)	P value	HR (95%CI)	P value	HR (95%CI)	P value	HR (95%CI)	P value
Race	1.066 (1.023-1.111)	0.003	1.080 (1.036-1.126)	< 0.001	1.068 (1.025-1.114)	0.002	1.066 (1.022-1.111)	0.003
Marital status	1.252 (1.178-1.329)	< 0.001	1.240 (1.167-1.317)	< 0.001	1.258 (1.185-1.336)	< 0.001	1.262 (1.189-1.341)	< 0.001
Primary site	0.885 (0.836-0.938)	< 0.001	0.925 (0.873-0.979)	0.008	0.876 (0.826-0.928)	< 0.001	0.858 (0.809-0.909)	< 0.001
Histology	1.155 (1.071-1.245)	< 0.001	1.044 (0.967-1.126)	0.272	1.074 (0.996-1.159)	0.065	1.077 (0.999-1.162)	0.054
Grade	1.270 (1.212-1.331)	< 0.001	1.311 (1.252-1.373)	< 0.001	1.256 (1.200-1.316)	< 0.001	1.244 (1.188-1.303)	< 0.001
T-stage	1.546 (1.471-1.626)	< 0.001	1.609 (1.532-1.690)	< 0.001	1.574 (1.499-1.654)	< 0.001	1.551 (1.477-1.630)	< 0.001
M-stage	5.132 (4.800-5.487)	< 0.001	5.772 (5.399-6.170)	< 0.001	5.017 (4.684-5.373)	< 0.001	4.716 (4.404-5.051)	< 0.001
N-stage	1.783 (1.710-1.860)	< 0.001	/	/	/	/	/	/
PLN	/	/	1.050 (1.046-1.054)	< 0.001	/	/	/	/
LNR	/	/	/	/	5.304 (4.773-5.895)	< 0.001	/	/
LODDS	/	/	/	/	/	/	1.345 (1.321-1.368)	< 0.001

HR: Hazard ratio; CI: Confidence interval; PLN: Positive lymph node; LNR: Lymph node ratio; LODDS: Log odds of positive lymph node.

Table 5 Prognostic efficiency of different lymph node status indicators in the training cohort

Endpoint	Filtered model	C-index	AIC	AUC
Endpoint	Filtered model	C-index	AIC	1-yr	3-yr	5-yr	10-yr
OS	N-stage	0.799	96473.30	0.835	0.844	0.842	0.818
	LN-positive	0.796	96726.02	0.835	0.845	0.838	0.811
	LNR	0.802	96299.43	0.840	0.849	0.842	0.817
	LODDS	0.806	96143.26	0.842	0.850	0.845	0.820
CSS	N-stage	0.826	74358.02	0.862	0.871	0.869	0.855
	LN-positive	0.822	74674.34	0.861	0.872	0.863	0.846
	LNR	0.829	74253.59	0.868	0.876	0.870	0.853
	LODDS	0.834	74084.86	0.870	0.877	0.872	0.857

AIC: Akaike information criterion; AUC: Area under the curve; C-index: Concordance index; OS: Overall survival; CSS: Cause-specific survival.

Citation: Xia HB, Chen C, Jia ZX, Li L, Xu AM. Advantage of log odds of positive lymph nodes in prognostic evaluation of patients with early-onset colon cancer. World J Gastrointest Surg 2023; 15(11): 2430-2444
URL: https://www.wjgnet.com/1948-9366/full/v15/i11/2430.htm
DOI: https://dx.doi.org/10.4240/wjgs.v15.i11.2430