Abstract
The staging system of remnant gastric cancer (RGC) has not yet been established, with the current staging being based on the guidelines for primary gastric cancer. Often, surgeries for RGC fail to achieve the > 15 lymph nodes needed for TNM staging. Compared with the pN staging system, lymph node ratio (NR) may be more accurate for RGC staging and prognosis prediction. We retrospectively analyzed the data of 208 patients who underwent R0 gastrectomy with curative intent and who have ≤ 15 retrieved lymph nodes (RLNs) for RGC between 2000 and 2014. The patients were divided into four groups on the basis of the NR cutoffs: rN0: 0; rN1: > 0 and ≤ 1/6; rN2: > 1/6 and ≤ 1/2; and rN3: > 1/2. The 5-year overall survival (OS) rates for rN0, rN1, rN2, and rN3 were 84.3%, 64.7%, 31.5%, and 12.7%, respectively. Multivariable analyses revealed that tumor size (p = 0.005), lymphovascular invasion (p = 0.023), and NR (p < 0.001), but not pN stage (p = 0.682), were independent factors for OS. When the RLN count is ≤ 15, the NR is superior to pN as an important and independent prognostic index of RGC, thus predicting the prognosis of RGC patients more accurately.
Highlights
The staging system of remnant gastric cancer (RGC) has not yet been established, with the current staging being based on the guidelines for primary gastric cancer
In the 8th UICC/AJCC TNM staging system, the amount of metastatic lymph node (LN) is used to determine the LN stage, and the number of retrieved lymph nodes (RLNs) must be > 15 to arrive at a more accurate LN staging. This appears to be inappropriate for RGC where RLNs can be < 16, in the case of radical lymphadenectomy for initial malignant disease[8]
Previous studies have shown that LN metastasis is an independent risk factor in RGC local recurrence
Summary
The staging system of remnant gastric cancer (RGC) has not yet been established, with the current staging being based on the guidelines for primary gastric cancer. Compared with the pN staging system, lymph node ratio (NR) may be more accurate for RGC staging and prognosis prediction. We retrospectively analyzed the data of 208 patients who underwent R0 gastrectomy with curative intent and who have ≤ 15 retrieved lymph nodes (RLNs) for RGC between 2000 and 2014. When the RLN count is ≤ 15, the NR is superior to pN as an important and independent prognostic index of RGC, predicting the prognosis of RGC patients more accurately. A retrieved lymph node (RLN) count of ≤ 15 may lead to false staging and affect treatment plans and prognosis. The metastatic lymph node (LN) ratio (NR) is reported to be more suitable for primary GC staging compared to a positive LN count, especially when the RLN is low[6]. We hypothesize that NR would be more exact than the UICC/AJCC pN stage (8th edition) for RGC staging, which we validated through a retrospective analysis
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call