Association of log odds of positive lymph nodes with survival in patients with small cell lung cancer: Results from the SEER database

Gao, Ting; Chang, Yingxuan; Yue, Hongmei

doi:10.1016/j.clinsp.2024.100369

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Sumário

Original articles • Clinics 79 • 2024 • https://doi.org/10.1016/j.clinsp.2024.100369 copy

Association of log odds of positive lymph nodes with survival in patients with small cell lung cancer: Results from the SEER database

Authorship SCIMAGO INSTITUTIONS RANKINGS

Highlights

The prognosis of patients with SCLC can be predicted by their LN status.
The authors aimed to assess the correlations between SCLC survival and LNR, pLNs, LODDS.
LODDS may be better than other LN assessment tools at predicting survival in SCLC.

Abstract

Objectives

The prognosis of patients with Small Cell Lung Cancer (SCLC) can be predicted by their Lymph Node (LN) status. The authors aimed to assess the correlations between SCLC survival and number of LN Ratio (LNR), positive LN (pLNs), and Logarithmic Odds of positive LN (LODDS).

Methods

This cohort study retrospectively included 1,762 patients with SCLC from the SEER database 2004‒2015. The X-tile software was used to determine the cutoff values for pLNs, LNR, and LODDS. The correlations between pLNs, LNR, and LODDS with Overall Survival (OS) and Cancer-Specific Survival (CSS) were explored using Cox regression analysis. The study used the C-index to assess the predictive value of LNR, pLNs, and LODDS on survival.

Results

Among these 1,762 patients, 121 (6.87%) were alive, 1,641 (93.13%) died, and 1,532 (86.95%) died of SCLC. In univariable COX analysis, LNR, pLNs, and LODDS all showed a correlation with CSS and OS (p < 0.05). In multivariable COX analysis, only patients with LODDS (> 0.3 vs. ≤ 0.3) were related to both worse OS (HR = 1.28, 95% CI 1.10‒1.50) and CSS (HR = 1.29, 95% CI 1.10‒1.51), but no correction was observed between LNR and pLNs and survival (p > 0.05). The C-indices for predicting OS for LODDS were 0.552 (95% CI 0.541‒0.563), for LNR 0.504 (95% CI 0.501‒0.507), and for pLNs 0.527 (95% CI 0.514‒0.540). Moreover, the association between LODDS and prognosis in SCLC patients was significant only in patients with LN stage N1 and N2, but not in stage N3.

Conclusion

LODDS may be better than other LN assessment tools at predicting survival in SCLC patients.

Keywords
SCLC; Lymph Node; Survival; LODDS; SEER

Variables	Total (n = 1762)	N1 stage (n = 184)	N2 stage (n = 999)	N3 stage (n = 579)	p
Age, years, n (%)					0.002
< 65	897 (50.91)	108 (58.70)	526 (52.65)	263 (45.42)
≥ 65	865 (49.09)	76 (41.30)	473 (47.35)	316 (54.58)
Sex, n (%)					0.625
Female	908 (51.53)	101 (54.89)	512 (51.25)	295 (50.95)
Male	854 (48.47)	83 (45.11)	487 (48.75)	284 (49.05)
Race, n (%)					0.115
American Indian/Alaska Native	13 (0.74)	0 (0.00)	8 (0.80)	5 (0.86)
Asian or Pacific Islander	75 (4.26)	4 (2.17)	38 (3.80)	33 (5.70)
Black	154 (8.74)	12 (6.52)	90 (9.01)	52 (8.98)
White	1520 (86.27)	168 (91.30)	863 (86.39)	489 (84.46)
Marital status, n (%)					0.089
Married	979 (55.56)	116 (63.04)	559 (55.96)	304 (52.50)
Others	568 (32.24)	51 (27.72)	325 (32.53)	192 (33.16)
Single	215 (12.20)	17 (9.24)	115 (11.51)	83 (14.34)
AJCC T, n (%)					<0.001
T1	328 (18.62)	61 (33.15)	210 (21.02)	57 (9.84)
T2	450 (25.54)	63 (34.24)	275 (27.53)	112 (19.34)
T3	83 (4.71)	9 (4.89)	46 (4.60)	28 (4.84)
TX	901 (51.14)	51 (27.72)	468 (46.85)	382 (65.98)
AJCC M, n (%)					<0.001
M0	913 (51.82)	143 (77.72)	542 (54.25)	228 (39.38)
M1	807 (45.80)	36 (19.57)	436 (43.64)	335 (57.86)
MX	42 (2.38)	5 (2.72)	21 (2.10)	16 (2.76)
Laterality, n (%)					0.002
Left ‒ origin of primary	627 (35.58)	77 (41.85)	337 (33.73)	213 (36.79)
Right ‒ origin of primary	1072 (60.84)	103 (55.98)	636 (63.66)	333 (57.51)
Others	63 (3.58)	4 (2.17)	26 (2.60)	33 (5.70)
Tumor grade, n (%)					<0.001
Grade I	4 (0.23)	0 (0.00)	4 (0.40)	0 (0.00)
Grade II	14 (0.79)	5 (2.72)	7 (0.70)	2 (0.35)
Grade III	193 (10.95)	38 (20.65)	115 (11.51)	40 (6.91)
Grade IV	297 (16.86)	56 (30.43)	166 (16.62)	75 (12.95)
Unknown	1254 (71.17)	85 (46.20)	707 (70.77)	462 (79.79)
Tumor size, n (%)					<0.001
≤ 50 mm	1365 (77.47)	163 (88.59)	790 (79.08)	412 (71.16)
> 50 mm	397 (22.53)	21 (11.41)	209 (20.92)	167 (28.84)
Primary Site, n (%)					<0.001
Main bronchus	193 (10.95)	10 (5.43)	118 (11.81)	65 (11.23)
Upper lobe, lung	847 (48.07)	92 (50.00)	500 (50.05)	255 (44.04)
Middle lobe, lung	83 (4.71)	10 (5.43)	45 (4.50)	28 (4.84)
Lower lobe, lung	310 (17.59)	51 (27.72)	169 (16.92)	90 (15.54)
Overlapping lesion of lung	28 (1.59)	6 (3.26)	8 (0.80)	14 (2.42)
Lung (NOS)	301 (17.08)	15 (8.15)	159 (15.92)	127 (21.93)
Surgery type, n (%)					<0.001
Lobectomy	157 (8.91)	89 (48.37)	66 (6.61)	2 (0.35)
Local tumor destruction	1 (0.06)	0 (0.00)	0 (0.00)	1 (0.17)
No surgery	1506 (85.47)	64 (34.78)	876 (87.69)	566 (97.75)
Pneumonectomy	15 (0.85)	9 (4.89)	6 (0.60)	0 (0.00)
Sublobectomy	74 (4.20)	21 (11.41)	45 (4.50)	8 (1.38)
Surgery (NOS)	9 (0.51)	1 (0.54)	6 (0.60)	2 (0.35)
Radiation, n (%)					0.015
No	969 (54.99)	89 (48.37)	578 (57.86)	302 (52.16)
Yes	793 (45.01)	95 (51.63)	421 (42.14)	277 (47.84)
Chemotherapy, n (%)					0.150
No	357 (20.26)	44 (23.91)	187 (18.72)	126 (21.76)
Yes	1405 (79.74)	140 (76.09)	812 (81.28)	453 (78.24)
Follow-up time, M (Q₁, Q₃)	11.00 (4.00, 20.00)	16.50 (7.00, 32.00)	11.00 (5.00, 22.00)	8.00 (3.00, 14.00)	<0.001
pLNs, n (%)					<0.001
1	1174 (66.63)	111 (60.33)	619 (61.96)	444 (76.68)
> 1	588 (33.37)	73 (39.67)	380 (38.04)	135 (23.32)
LNR n (%)					<0.001
≤ 0.05	14 (0.79)	9 (4.89)	5 (0.50)	0 (0.00)
> 0.05	1748 (99.21)	175 (95.11)	994 (99.50)	579 (100.00)
LODDS, n (%)					<0.001
≤ 0.3	342 (19.41)	110 (59.78)	190 (19.02)	42 (7.25)
> 0.3	1420 (80.59)	74 (40.22)	809 (80.98)	537 (92.75)
OS, n (%)					<0.001
Yes	121 (6.87)	28 (15.22)	79 (7.91)	14 (2.42)
No	1641 (93.13)	156 (84.78)	920 (92.09)	565 (97.58)
CSS, n (%)					<0.001
Yes	230 (13.05)	37 (20.11)	149 (14.91)	44 (7.60)
No	1532 (86.95)	147 (79.89)	850 (85.09)	535 (92.40)

		Univariable analysis		Multivariable analysis
Outcomes	Variables	HR (95%CI)	p	HR (95%CI)	p
OS	LODDS
	≤ 0.3	Ref		Ref
	> 0.3	1.69 (1.49‒1.92)	<0.001	1.28 (1.10‒1.50)	0.001
	pLNs
	1	Ref		Ref
	> 1	0.84 (0.76‒0.93)	<0.001	0.96 (0.87‒1.07)	0.482
	LNR
	≤ 0.05	Ref		Ref
	> 0.05	2.37 (1.27‒4.42)	0.006	1.51 (0.80‒2.86)	0.207
CSS	LODDS
	≤ 0.3	Ref		Ref
	> 0.3	1.71 (1.50‒1.95)	<0.001	1.29 (1.10‒1.51)	0.002
	pLNs
	1	Ref		Ref
	> 1	0.81 (0.73‒0.90)	<0.001	0.93 (0.83‒1.04)	0.191
	LNR
	≤ 0.05	Ref		Ref
	> 0.05	2.19 (1.17‒4.07)	0.014	1.38 (0.73‒2.62)	0.322

			Univariable analysis		Multivariable analysis
Outcomes	N-staging	Variables	HR (95%CI)	P	HR (95%CI)	P
OS	N1	LODDS
		≤ 0.3	Ref		Ref
		> 0.3	2.02 (1.47-2.78)	<0.001	1.60 (1.01-2.54)	0.044
		pLNs
		1	Ref		Ref
		> 1	0.78 (0.56-1.08)	0.135	0.97 (0.67-1.41)	0.881
		LNR
		≤ 0.05	Ref		Ref
		> 0.05	1.26 (0.59-2.70)	0.545	1.09 (0.47-2.52)	0.836
	N2	LODDS
		≤ 0.3	Ref		Ref
		> 0.3	1.46 (1.23-1.72)	<0.001	1.33 (1.09-1.61)	0.005
		pLNs
		1	Ref		Ref
		> 1	0.92 (0.80-1.05)	0.212	0.99 (0.86-1.13)	0.834
		LNR
		≤ 0.05	Ref		Ref
		> 0.05	3.44 (1.11-10.68)	0.033	2.26 (0.72-7.10)	0.164
	N3	LODDS
		≤ 0.3	Ref		Ref
		> 0.3	1.20 (0.87-1.66)	0.261	1.09 (0.79-1.51)	0.601
		pLNs
		1	Ref		Ref
		> 1	0.89 (0.73-1.08)	0.224	0.90 (0.73-1.10)	0.312
		LNR
		≤ 0.05	-		-
		> 0.05	-	-	-	-
CSS	N1	LODDS
		≤ 0.3	Ref		Ref
		> 0.3	1.97 (1.42-2.73)	<0.001	1.48 (0.93-2.37)	0.100
		pLNs
		1	Ref		Ref
		> 1	0.80 (0.57-1.11)	0.184	1.03 (0.70-1.50)	0.888
		LNR
		≤ 0.05	Ref		Ref
		> 0.05	1.19 (0.56-2.55)	0.652	1.02 (0.44-2.36)	0.96
	N2	LODDS
		≤ 0.3	Ref		Ref
		> 0.3	1.50 (1.26-1.79)	<0.001	1.34 (1.09-1.65)	0.005
		pLNs
		1	Ref		Ref
		> 1	0.87 (0.76-1.00)	0.053	0.93 (0.80-1.07)	0.324
		LNR
		≤ 0.05	Ref		Ref
		> 0.05	3.13 (1.01-9.73)	0.049	1.99 (0.63-6.27)	0.240
	N3	LODDS
		≤ 0.3	Ref		Ref
		> 0.3	1.18 (0.85-1.65)	0.314	1.09 (0.78-1.53)	0.606
		pLNs
		1	Ref		Ref
		> 1	0.87 (0.71-1.06)	0.170	0.90 (0.73-1.11)	0.310
		LNR
		≤ 0.05	-		-
		> 0.05	-		-	-

Outcomes	Populations	Variables	C-index (95%CI)	P
OS	Overall	LODDS	0.552 (0.541-0.563)	Ref
		pLNs	0.527 (0.514-0.540)	0.004
		LNR	0.504 (0.501-0.507)	<0.001
	N1 stage	LODDS	0.601 (0.560-0.641)	Ref
		pLNs	0.545 (0.502-0.588)	0.065
		LNR	0.505 (0.486-0.525)	<0.001
	N2 stage	LODDS	0.540 (0.525-0.554)	Ref
		pLNs	0.514 (0.496-0.532)	0.030
		LNR	0.504 (0.500-0.507)	<0.001
	N3 stage	LODDS	0.509 (0.497-0.522)	Ref
		pLNs	0.521 (0.500-0.541)	0.331
		LNR	-
CSS	Overall	LODDS	0.554 (0.543-0.565)	Ref
		pLNs	0.531 (0.518-0.545)	0.008
		LNR	0.504 (0.501-0.507)	<0.001
	N1 stage	LODDS	0.602 (0.560-0.643)	Ref
		pLNs	0.543 (0.499-0.586)	0.057
		LNR	0.504 (0.484-0.525)	<0.001
	N2 stage	LODDS	0.543 (0.528-0.557)	Ref
		pLNs	0.520 (0.501-0.539)	0.063
		LNR	0.504 (0.500-0.507)	<0.001
	N3 stage	LODDS	0.511 (0.498-0.523)	Ref
		pLNs	0.523 (0.502-0.544)	0.341
		LNR	-	-

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[1] Declaration of competing interest

The authors declare no conflicts of interest.