ArticleGland surgery2026
The clinical relevance of LODDS for post-mastectomy radiotherapy in T1-2N1M0 breast cancer: a real-world propensity score-weighted analysis using the SEER database.
Article in Gland surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: The benefit of postmastectomy radiotherapy (PMRT) in patients with T1-2N1M0 breast cancer remains heterogeneous. This study evaluated whether the log odds of positive lymph nodes (LODDS) could stratify PMRT-associated survival benefit in this population. Methods: This study was designed as a retrospective observational cohort study using data from the Surveillance, Epidemiology, and End Results (SEER) database. Patients with T1-2N1M0 breast cancer who underwent mastectomy between 2010 and 2018 were identified from the SEER database. LODDS was calculated as log [(positive lymph nodes + 0.5)/(negative lymph nodes + 0.5)] and categorized into low, intermediate, and high groups. Inverse probability of treatment weighting (IPTW) was used to balance baseline characteristics. Breast cancer-specific survival (BCSS) and overall survival (OS) were analyzed using Kaplan-Meier curves and Cox regression models. Results: A total of 28,864 patients were included, of whom 12,481 received PMRT and 16,383 did not. After IPTW, baseline characteristics were well balanced. PMRT was associated with improved BCSS [hazard ratio =0.776, 95% confidence interval (CI): 0.723-0.833, P<0.001] and OS (hazard ratio =0.800, 95% CI: 0.759-0.844, P<0.001). The association between PMRT and BCSS differed by LODDS group (P for interaction =0.048). PMRT was not significantly associated with improved BCSS in the low LODDS group (hazard ratio =0.895, 95% CI: 0.779-1.028, P=0.12), but was associated with improved BCSS in the intermediate and high LODDS groups (P<0.001). Conclusions: PMRT was associated with improved survival in patients with T1-T2N1M0 breast cancer after mastectomy, especially among those with intermediate or high LODDS. LODDS may help refine PMRT decision-making beyond N stage alone.
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