Log Odds of Positive Lymph Nodes Improves Risk Stratification for Early Recurrence and Survival After Radical
Byung Jo Park1, Tae Hee Hong1, Young Ho Yang1
1Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea.
Background:
Early recurrence after curative resection for cT3 esophageal squamous cell carcinoma (ESCC) is strongly associated with poor long-term survival. Identifying patients at high risk of early recurrence may improve postoperative risk stratification and inform tailored surveillance or adjuvant therapy.
Patients And Methods:
We retrospectively analyzed patients who underwent en bloc esophagectomy with three-field lymphadenectomy. The log odds of positive lymph nodes (LODDS) were calculated as log([number of positive nodes + 0.5]/[number of negative nodes + 0.5]). Early recurrence was defined using maximally selected rank statistics. Independent risk factors for early recurrence were identified using multivariable Firth logistic regression, followed by decision tree analysis to establish hierarchical risk stratification.
Results:
Among 121 patients, 109 (90.1%) achieved R0 resection. The median numbers of dissected and metastatic lymph nodes were 67.0 and 2.0, respectively, with a median LODDS of - 3.46. Early recurrence was defined as recurrence within 16.6 months after surgery. Multivariable analysis identified higher LODDS, upper thoracic location, and resectability status (resectable or borderline resectable) as independent predictors of early recurrence. In the complementary tree-based analysis, early recurrence risk was primarily stratified by LODDS using a cut-off of - 2.69. Patients with LODDS > - 2.69 had significantly worse 5-year overall survival than those with LODDS ≤ -2.69 (30.0% versus 66.1%, p < 0.001). Among patients with LODDS ≤ - 2.69, tumor location further refined risk stratification.
Conclusions:
LODDS provides a robust and clinically applicable metric for postoperative risk stratification of early recurrence in patients undergoing radical esophagectomy for cT3 ESCC.
