A prognostic nomogram based on log odds of positive lymph nodes to predict survival in gastric cancer patients with neoadjuvant chemotherapy: a large population-based cohort study and external validation.

Authors

Jun Yang, Yuheng Jin, Xiangning Chen, Wei Jin, Pengfei Wang, Fanghao Mao, Jun Cheng, Jinji Jin

Published in

Journal of gastrointestinal oncology. Volume 17. Issue 3. Pages 144. Jun 30, 2026. Epub Apr 23, 2026.

Abstract

Neoadjuvant chemotherapy is the standard treatment for advanced gastric cancer (GC), yet a considerable proportion of patients gain no survival benefit and frequently present with regional lymph node metastasis. Few prognostic models have specifically incorporated lymph node-related parameters in this setting. The lymph node ratio (LNR) and the LODDS have been reported by several studies to have great predictive ability compared to LNR in patients with partial GC. In this study, we aimed to explore the potential value of various clinical features (including but not limited to LNR and LODDS) in predicting the outcomes of gastric cancer patients who receive systemic therapy before surgery.
We retrospectively identified 726 GC patients who underwent neoadjuvant chemotherapy and subsequent surgery from the Surveillance, Epidemiology, and End Results (SEER) database (2004-2019). Patients were randomly divided into a training cohort (n=510) and an internal validation cohort (n=216). An external validation cohort consisted of 124 patients from The First Affiliated Hospital of Wenzhou Medical University. Optimal cut-off values were determined using the Kaplan-Meier method. Univariate and multivariable logistic and Cox regression analyses were performed for variable screening. A prognostic nomogram incorporating independent risk factors was constructed and validated using the concordance index (C-index) and time-dependent receiver operating characteristic (ROC) curves.
Primary tumor site, T stage, N stage, and log odds of positive lymph nodes (LODDS) were identified as independent prognostic factors and integrated into the nomogram. The nomogram yielded a C-index of 0.755 in the training cohort, 0.732 in the internal validation cohort, and 0.809 in the external validation cohort. The 1-, 3-, and 5-year areas under the curves (AUCs) were 0.780, 0.790, and 0.803 in the training cohort; 0.742, 0.730, and 0.752 in the internal validation cohort; and 0.747, 0.777, and 0.725 in the external validation cohort, respectively.
LODDS is an independent prognostic indicator in GC patients receiving neoadjuvant chemotherapy. The newly developed nomogram provides accurate individualized survival prediction in this population.

PMID:
42434240
Bibliographic data and abstract were imported from PubMed on 11 Jul 2026.

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