Abstract
BACKGROUND: Staging of malignant tumours based on positive lymph node number and not taking into account the actual number of examined lymph nodes during surgery may lead to bias and fallacious results. The ratio of positive and resected lymph nodes (LNR) and log odds of positive nodes (LODDS) emerged as novel prognostic markers in deciding the future course of management better than the parameter pN in predicting cancer-specific survival. We aim to evaluate and compare the prognostic value of pN, LNR and LODDS in common primary organ malignancies like breast, head and neck, gastric and cervical cancers. METHODS: This was an ambidirectional observational study conducted from September 2018 to August 2021 with one year (from 2017 to 2018) for retrospective data collection archived from records. It included patients affected by breast, head and neck, gastric and cervical cancers and were followed up for a period of 3 years from the date of diagnosis to perform a holistic survival analysis. The sample was grouped by American Joint Committee on Cancer N stage, LNR and LODDS, and analysed using Kaplan-Meier and multivariate Cox proportional hazard models. RESULTS: The study included 202 breast cancer patients, 85 head and neck cancer patients, 100 gastric cancer patients and 52 cervical cancer patients. Multivariate Cox regressions analysis demonstrated a lower Akaike Information Criterion (AIC) value for LODDS and LNR followed by pN stage. CONCLUSION: The novel indicators LNR and LODDS better predicted the biological behaviour irrespective of lymph node number and allowed clinicians to correctly stratify patients for better postoperative management.