Prognostic Value of Log Odds of Positive Lymph Nodes (LODDS) in Gastric Cancer: A Comparative Analysis with Lymph Node Ratio and N Stage

Objective: The present analysis sought to compare the prognostic relevance of log odds of positive lymph nodes (LODDS), lymph node ratio (LNR), and standard N-based staging in patients who received curative-intent surgical treatment for stomach cancer.Methods: Medical records of patients who underwent curative gastrectomy between March 2019 and March 2025 were examined retrospectively.Clinicopathological characteristics, together with lymph node-related parameters, were analyzed.The Kaplan-Meier method was used to estimate survival, and differences across groups were evaluated using the log-rank test.Prognostic factors were investigated through univariate and multivariate Cox regression analyses.Separate multivariate models were constructed for LNR, LODDS, and N stage to account for potential collinearity among nodal variables.Discriminative performance was additionally examined by constructing receiver operating characteristic (ROC) plots, and findings yielding P values under 0.05 were taken to be statistically meaningful. Results:The analytical cohort comprised 55 cases observed over a median surveillance duration of 29 months.Univariate analysis identified five factors significantly associated with survival: tumor (T) category, node (N) classification, tumor differentiation grade, LNR, and LODDS.Once multivariate correction was applied, the prognostic value of LODDS was preserved as an independent prognostic marker (hazard ratio: 3.159; 95% confidence interval: 1.484-6.722;P = 0.003), whereas LNR no longer reached significance.Although N stage retained prognostic relevance, its predictive strength was lower than that observed for LODDS.ROC analysis demonstrated favorable predictive performance for all nodal parameters, with LODDS showing the highest AUC value (0.876).Conclusion: In gastric cancer, LODDS appears to retain prognostic relevance for overall survival and may provide superior discriminative ability compared with conventional nodal staging systems.