Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Mar 15, 2024; 16(3): 833-843
Published online Mar 15, 2024. doi: 10.4251/wjgo.v16.i3.833
Predictive value of positive lymph node ratio in patients with locally advanced gastric remnant cancer
Meng Zhuo, Lei Tian, Ting Han, Teng-Fei Liu, Xiao-Lin Lin, Xiu-Ying Xiao
Meng Zhuo, Ting Han, Teng-Fei Liu, Xiao-Lin Lin, Xiu-Ying Xiao, Department of Oncology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
Lei Tian, Department of Oncology, Hebei General Hospital, Shijiazhuang 050051, Hebei Province, China
Co-first authors: Meng Zhuo, Lei Tian and Ting Han.
Co-corresponding authors: Xiu-Ying Xiao and Xiao-Lin Lin.
Author contributions: Zhuo M and Tian L contributed to conception, design, data analysis, and manuscript drafting and editing; Han T and Liu TF contributed to collection, assembly of data and revised the manuscript; Lin XL and Xiao XY contributed to conception, resources, and manuscript review and editing; all authors have read and approved the final manuscript.
Supported by Shanghai Municipal Committee of Science and Technology, No. 21Y11913200.
Institutional review board statement: This study was approved by the Ethics Committee of Renji Hospital.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xiu-Ying Xiao, MD, PhD, Doctor, Department of Oncology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160 Pujian Road, Shanghai 200127, China. xiaoxiuying2002@163.com
Received: October 11, 2023
Peer-review started: October 11, 2023
First decision: December 5, 2023
Revised: December 19, 2023
Accepted: January 24, 2024
Article in press: January 24, 2024
Published online: March 15, 2024
Processing time: 153 Days and 2.1 Hours
Abstract
BACKGROUND

Traditional lymph node stage (N stage) has limitations in advanced gastric remnant cancer (GRC) patients; therefore, establishing a new predictive stage is necessary.

AIM

To explore the predictive value of positive lymph node ratio (LNR) according to clinicopathological characteristics and prognosis of locally advanced GRC.

METHODS

Seventy-four patients who underwent radical gastrectomy and lymphadenectomy for locally advanced GRC were retrospectively reviewed. The relationship between LNR and clinicopathological characteristics was analyzed. The survival analysis was performed using Kaplan-Meier survival curves and Cox regression model.

RESULTS

Number of metastatic LNs, tumor diameter, depth of tumor invasion, Borrmann type, serum tumor biomarkers, and tumor-node-metastasis (TNM) stage were correlated with LNR stage and N stage. Univariate analysis revealed that the factors affecting survival included tumor diameter, anemia, serum tumor biomarkers, vascular or neural invasion, combined resection, LNR stage, N stage, and TNM stage (all P < 0.05). The median survival time for those with LNR0, LNR1, LNR2 and LNR3 stage were 61, 31, 23 and 17 mo, respectively, and the differences were significant (P = 0.000). Anemia, tumor biomarkers and LNR stage were independent prognostic factors for survival in multivariable analysis (all P < 0.05).

CONCLUSION

The new LNR stage is uniquely based on number of metastatic LNs, with significant prognostic value for locally advanced GRC, and could better differentiate overall survival, compared with N stage.

Keywords: Gastric remnant cancer; Positive lymph node ratio; Clinicopathological characteristics; Prognosis

Core Tip: Lymph node (LN) counts of gastric remnant cancer (GRC) patients are often insufficient, and the prognostic ability of traditional LN stage (N stage) is therefore limited. This study investigated the predictive value of LN ratio (LNR) according to clinicopathological characteristics and prognosis of patients with locally advanced GRC. Compared with N stage, the new LNR stage had significant prognostic value for patients with locally advanced GRC, and it could better differentiate overall survival in patients, compared with N stage.