Log odds of positive lymph nodes as a prognostic marker in resectable triple negative breast cancer

This study aimed to assess the prognostic value of the log odds of positive lymph nodes (LODDS) in resectable nonmetastatic triple-negative breast cancer (TNBC) and its potential role in informing postoperative treatment decisions. A retrospective cohort study was conducted using data from the SEER 17 registries, including patients aged 20-79 diagnosed with TNBC. The association between LODDS and cancer-specific survival (CSS) was analyzed using the restrictive cubic splines (RCS) method. Propensity score matching (PSM) and survival analysis were employed to evaluate the effect of LODDS on treatment outcomes. Between 2010 and 2021, breast-conserving surgery (BCS) emerged as the predominant surgical approach for resectable nonmetastatic TNBC, with its proportion increasing from 49.3 to 52.1%, while mastectomy rates declined from 46.5 to 38.9%. RCS analysis identified a significant nonlinear association (p < 0.001) between LODDS and CSS, with a threshold value of -1.6 effectively categorizing patients into low-risk (LODDS < -1.6) and high-risk (LODDS > -1.6) groups. Patients in the low-risk group exhibited superior survival, with 5-year and 10-year CSS rates improving by 7.3% and 8.4%, respectively, following PSM. Notably, BCS was associated with better survival outcomes compared to mastectomy, particularly in high-risk LODDS patients. Stratified analysis by LODDS and age revealed that BCS followed by radiotherapy conferred the most substantial survival benefit. LODDS is a reliable prognostic marker for survival outcomes in resectable nonmetastatic TNBC. Incorporating LODDS into age-based risk stratification can facilitate more personalized postoperative management following BCS.