Log Odds of Positive Lymph Nodes as a Novel Prognostic Predictor for Bladder Cancer: A Systematic Review and Meta-Analysis.

Accurate lymph node staging is vital for bladder cancer (BC) prognostication. The log odds of positive lymph nodes (LODDS) is a promising prognostic indicator, but its utility in BC has not been systematically reviewed. This meta-analysis evaluated LODDS prognostic value for survival outcomes in BC patients undergoing radical cystectomy (RC). We searched PubMed, Web of Science, Scopus, and Embase from inception to July 31, 2025 for observational studies assessing LODDS and survival in BC patients post-RC. Two reviewers independently performed study selection, extraction, and quality assessment using Strengthening the Reporting of Observational studies in Epidemiology checklist and Newcastle-Ottawa Scale. Hazard ratios (HR) and 95% confidence intervals (CI) were pooled using random-effects models. The study protocol was registered in International Prospective Register of Systematic Reviews (CRD42023438247). Five retrospective studies (24,978 patients) were included. Continuous LODDS was significantly associated with improved overall survival (OS) (univariable HR = 2.11 [95% CI, 2.02-2.21]; multivariable HR = 1.65 [95% CI, 1.57-1.73]) and cancer-specific survival risk (univariable HR = 2.36 [95% CI, 2.25-2.48]; multivariable HR = 1.65 [95% CI, 1.57-1.73]). Categorical LODDS showed progressively worse OS in the univariable analysis (HR = 3.49 [95% CI, 1.11-10.92]) but no statistical significance in the multivariable analysis (HR = 2.07 [95% CI, 0.88-4.92]), with substantial heterogeneity (I² > 93%). Categorical LODDS application faces challenges due to lack of standardized cutoffs and high heterogeneity across studies. Continuous LODDS is a robust prognostic factor for BC survival post-RC, outperforming traditional metrics. Clinicians may consider incorporating continuous LODDS into risk stratification to identify high-risk patients for intensified surveillance or adjuvant therapy. Categorical LODDS should be used with caution until standardized thresholds are established.