Updates in Surgery

, Volume 70, Issue 1, pp 23–31 | Cite as

The impact of log odds of positive lymph nodes (LODDS) in colon and rectal cancer patient stratification: a single-center analysis of 323 patients

  • Andrea Scarinci
  • Tatiana Di Cesare
  • Daniele Cavaniglia
  • Tiziano Neri
  • Michelle Colletti
  • Giulia Cosenza
  • Andrea Liverani
Original Article


Log odds of positive nodes (LODDS), defined as the log of the ratio between the number of positive nodes and the number of negative nodes, has been recently introduced as a tool in predicting prognosis. This study aims to establish the effective and prognostic value of LODDS in predicting the survival outcome of CRC patients undergoing surgical resection. The study population is represented by 323 consecutive patients with primary colon or rectal adenocarcinoma thatunderwent curative resection. LODDS values were calculated by empirical logistic formula, log(pnod + 0.5)/(tnod − pnod + 0.5). It was defined as the log of the ratio between the number of positive nodes and the number of negative nodes. The patients were divided into three groups: LODDS0 (≤ − 1.36), LODDS1 (> − 1.36 ≤ − 0.53) and LODDS2 (> − 0.53). Kaplan–Meier curve analyses showed 3-year OS rates of the patients staged by LODDS classification. These values were 88.3, 74.8 and 61.8% for LODDS0, LODDS1 and LODDS2, respectively (P ≤ 0.001). In a multivariate analysis, LODDS is an independent prognostic factor of 3-year OS. This is in contrast to pN stage and lymph node ratio, which shows no statistical significance. ROC analyses showed that LODDS predicted OS better than lymph node ratio. LODDS classification has a better prognostic effect than pN stage and lymph node ratio. LODDS offers a finer stratification and accurately predicts survival of CRC patients.


Colon cancer Rectum cancer LODDS Adenocarcinoma Lymph nodes 


Compliance with ethical standards

Conflict of interest

The authors declare that there is no potential conflict of interest.

Research involving human participants and/or animals

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (Institutional and National) and with the Helsinki Declaration of 1964 and later versions.

Informed consent

Informed consent was obtained from all patients for being included in the study.


  1. 1.
    Jemal A, Siegel R, Xu J et al (2010) Cancer statistics. CA Cancer J Clin 60:277–300CrossRefPubMedGoogle Scholar
  2. 2.
    Nelson H, Petrelli N, Carlin A et al (2001) Guidelines 2000 for colon and rectal cancer surgery. J Natl Cancer Inst 93:583–596CrossRefPubMedGoogle Scholar
  3. 3.
    Sobin LH, Gospodarowicz MK, Wittekind C (2010) TNM classification of malignant tumors, 7th edn. Wiley-Blackwell, OxfordGoogle Scholar
  4. 4.
    Compton C, Fenoglio-Preiser CM, Pettigrew N, Colorectal Working Group et al (2000) American Joint Committee on Cancer prognostic factors consensus conference. Cancer 88:1739–1757CrossRefPubMedGoogle Scholar
  5. 5.
    Engstrom PF, Benson AB 3rd, Chen YJ et al (2005) Colon cancer clinical practice guidelines in oncology. J Natl Compr Cancer Netw 3:468–491CrossRefGoogle Scholar
  6. 6.
    National Comprehensive Cancer Network (NCCN) Clinical practice guidelines in oncology (NCCN Guidelines TM). Colon cancer. Version 3.2011.
  7. 7.
    Stocchi L, Fazio VW, Lavery I et al (2011) Individual surgeon, pathologist, and other factors affecting lymph node harvest in stage II colon carcinoma. Is a minimum of 12 examined lymph nodes sufficient? Ann Surg Oncol 2(18):405–412CrossRefGoogle Scholar
  8. 8.
    Goldstein NS (2002) Lymph node recoveries from 2427 pT3 colorectal resection specimens spanning 45 years: recommendations for a minimum number of recovered lymph nodes based on predictive probabilities. Am J Surg Pathol 26:179–189CrossRefPubMedGoogle Scholar
  9. 9.
    Sarli L, Bader G, Iusco D et al (2005) Number of lymph nodes examined and prognosis of TNM stage II colorectal cancer. Eur J Cancer 41:272–279CrossRefPubMedGoogle Scholar
  10. 10.
    Swanson RS, Compton CC, Stewart A et al (2003) The prognosis of T3N0 colon cancer is dependent on the number of lymph nodes examined. Ann Surg Oncol 10:65–71CrossRefPubMedGoogle Scholar
  11. 11.
    Baxter NN, Virnig DJ, Rothenberger DA et al (2005) Lymph node evaluation in colorectal cancer patients: a population-based study. J Natl Cancer Inst 97:219–225CrossRefPubMedGoogle Scholar
  12. 12.
    Lu YJ, Lin PC, Lin CC et al (2013) The impact of the lymph node ratio is greater than traditional lymph node status in stage III colorectal cancer patients. World J Surg 37:1927–1933CrossRefPubMedGoogle Scholar
  13. 13.
    Rosenberg R, Friederichs J, Schuster T et al (2008) Prognosis of patients with colorectal cancer is associated with lymph node ratio: a single-center analysis of 3,026 patients over a 25-year time period. Ann Surg 248:968–978CrossRefPubMedGoogle Scholar
  14. 14.
    Wang J, Hassett JM, Dayton MT et al (2008) The prognostic superiority of log odds of positive lymph nodes in stage III colon cancer. J Gastrointest Surg 12:1790–1796CrossRefPubMedGoogle Scholar
  15. 15.
    Arslan NC, Sokmen S, Canda AE et al (2014) The prognostic impact of log odds of positive lymph nodes in colon cancer. Colorectal Dis 16(11):O386–O392CrossRefPubMedGoogle Scholar
  16. 16.
    Persiani R, Cananzi FC, Biondi A et al (2012) Log odds of positive lymph nodes in colon cancer: a meaningful ratio-based lymph node classification system. World J Surg 36:667–674CrossRefPubMedGoogle Scholar
  17. 17.
    Song YX, Gao P, Wang ZN et al (2011) Which is the most suitable classification for colorectal cancer, log odds, the number or the ratio of positive lymph nodes? PLoS One 6(12):e28937CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Compton CC, Fielding LP, Burgart LJ et al (2000) Prognostic factors in colorectal cancer. College of American Pathologists Consensus Statement 1999. Arch Pathol Lab Med 124:979–994PubMedGoogle Scholar
  19. 19.
    Edge SB, Byrd DR, Compton CC et al (2010) AJCC cancer staging manual, 7th edn. Springer, New YorkGoogle Scholar
  20. 20.
    Okusa T, Nakane Y, Boku T et al (1990) Quantitative analysis of nodal involvement with respect to survival rate after curative gastrectomy for carcinoma. Surg Gynecol Obstet 170(6):488–494PubMedGoogle Scholar
  21. 21.
    Siewert JR, Bottcher K, Stein HJ et al (1998) Relevant prognostic factors in gastric cancer: ten-year results of the German Gastric Cancer Study. Ann Surg 228(4):449–461CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Aurello P, Petrucciani N, Nigri GR et al (2014) Log odds of positive lymph nodes (LODDS): what are their role in the prognostic assessment of gastric adenocarcinoma? J Gastrointest Surg 18(7):1254–1260CrossRefPubMedGoogle Scholar
  23. 23.
    Sun Z, Xu Y, de Li M et al (2010) Log odds of positive lymph nodes: a novel prognostic indicator superior to the number-based and the ratio-based N category for gastric cancer patients with R0 resection. Cancer 116(11):2571–2580CrossRefPubMedGoogle Scholar

Copyright information

© Italian Society of Surgery (SIC) 2018

Authors and Affiliations

  • Andrea Scarinci
    • 1
  • Tatiana Di Cesare
    • 1
  • Daniele Cavaniglia
    • 1
  • Tiziano Neri
    • 1
  • Michelle Colletti
    • 2
  • Giulia Cosenza
    • 1
  • Andrea Liverani
    • 1
  1. 1.Department of General SurgeryRegina Apostolorum HospitalRomeItaly
  2. 2.Department of Surgery, Colorectal ServiceMemorial Sloan Kettering Cancer CenterNew YorkUSA

Personalised recommendations