Staging for Remnant Gastric Cancer: The Metastatic Lymph Node Ratio vs. the UICC 7th Edition System

Masatoshi Nakagawa, Yoon Young Choi, Ji Yeong An, Jung Hwa Hong, Jong Won Kim, Hyung Il Kim, Jae Ho Cheong, WooJin Hyung, Seung Ho Choi, Sung Hoon Noh

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10 Citations (Scopus)

Abstract

Background: Unlike primary gastric cancer, a remnant gastric cancer (RGC) staging system has not been established. The retrieved lymph node counts (RLN) in RGC is generally lower than that in primary gastric cancer, so it is unclear whether positive lymph node count reflects the RGC patient’s survival. Therefore, the lymph node ratio (LR) may be more useful for RGC staging than the 7th edition UICC classification. Methods: Patients (n = 191) who underwent gastrectomy with curative intent for RGC participated in this study. LR was classified as LR = 0, 0 < LR ≤ 0.1, 0.1 < LR ≤ 0.4, and 0.4 < LR. Modified TNM staging (mTNM-LR) was established by combining the pT (7th UICC) with LR. The predictive accuracy of LR and mTNM-LR was compared with that of the pN (7th UICC) and TNM (7th UICC), respectively. Results: The mean RLN was 14.4 and that of 128 patients (67 %) was ≤15. Fifty-one patients (27 %) had metastatic lymph nodes. Multivariable analyses revealed that pT (7th UICC) (p < 0.001) and pN (7th UICC) (p = 0.001), but not LR, were independent risk factors for overall survival. The overall c-index (95 % confidence interval) of each staging system was as follows: pN (7th UICC): 0.700 (0.627–0.771); LR: 0.701 (0.627–0.775), TNM (7th UICC): 0.808 (0.761–0.870); mTNM-LR: 0.807 (0.737–0.871). There were no significant differences in the predictive accuracy between pN (7th UICC) and LR, and TNM (7th UICC) and mTNM-LR. Conclusions: LR was not superior to pN (7th UICC). Thus, the 7th edition UICC classification is a practical and reliable staging system for RGC.

Original languageEnglish
Pages (from-to)4322-4331
Number of pages10
JournalAnnals of Surgical Oncology
Volume23
Issue number13
DOIs
Publication statusPublished - 2016 Dec 1

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Gastric Stump
Stomach Neoplasms
Lymph Nodes
Neoplasm Staging

All Science Journal Classification (ASJC) codes

  • Surgery
  • Oncology

Cite this

Nakagawa, M., Choi, Y. Y., An, J. Y., Hong, J. H., Kim, J. W., Kim, H. I., ... Noh, S. H. (2016). Staging for Remnant Gastric Cancer: The Metastatic Lymph Node Ratio vs. the UICC 7th Edition System. Annals of Surgical Oncology, 23(13), 4322-4331. https://doi.org/10.1245/s10434-016-5390-1
Nakagawa, Masatoshi ; Choi, Yoon Young ; An, Ji Yeong ; Hong, Jung Hwa ; Kim, Jong Won ; Kim, Hyung Il ; Cheong, Jae Ho ; Hyung, WooJin ; Choi, Seung Ho ; Noh, Sung Hoon. / Staging for Remnant Gastric Cancer : The Metastatic Lymph Node Ratio vs. the UICC 7th Edition System. In: Annals of Surgical Oncology. 2016 ; Vol. 23, No. 13. pp. 4322-4331.
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title = "Staging for Remnant Gastric Cancer: The Metastatic Lymph Node Ratio vs. the UICC 7th Edition System",
abstract = "Background: Unlike primary gastric cancer, a remnant gastric cancer (RGC) staging system has not been established. The retrieved lymph node counts (RLN) in RGC is generally lower than that in primary gastric cancer, so it is unclear whether positive lymph node count reflects the RGC patient’s survival. Therefore, the lymph node ratio (LR) may be more useful for RGC staging than the 7th edition UICC classification. Methods: Patients (n = 191) who underwent gastrectomy with curative intent for RGC participated in this study. LR was classified as LR = 0, 0 < LR ≤ 0.1, 0.1 < LR ≤ 0.4, and 0.4 < LR. Modified TNM staging (mTNM-LR) was established by combining the pT (7th UICC) with LR. The predictive accuracy of LR and mTNM-LR was compared with that of the pN (7th UICC) and TNM (7th UICC), respectively. Results: The mean RLN was 14.4 and that of 128 patients (67 {\%}) was ≤15. Fifty-one patients (27 {\%}) had metastatic lymph nodes. Multivariable analyses revealed that pT (7th UICC) (p < 0.001) and pN (7th UICC) (p = 0.001), but not LR, were independent risk factors for overall survival. The overall c-index (95 {\%} confidence interval) of each staging system was as follows: pN (7th UICC): 0.700 (0.627–0.771); LR: 0.701 (0.627–0.775), TNM (7th UICC): 0.808 (0.761–0.870); mTNM-LR: 0.807 (0.737–0.871). There were no significant differences in the predictive accuracy between pN (7th UICC) and LR, and TNM (7th UICC) and mTNM-LR. Conclusions: LR was not superior to pN (7th UICC). Thus, the 7th edition UICC classification is a practical and reliable staging system for RGC.",
author = "Masatoshi Nakagawa and Choi, {Yoon Young} and An, {Ji Yeong} and Hong, {Jung Hwa} and Kim, {Jong Won} and Kim, {Hyung Il} and Cheong, {Jae Ho} and WooJin Hyung and Choi, {Seung Ho} and Noh, {Sung Hoon}",
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Nakagawa, M, Choi, YY, An, JY, Hong, JH, Kim, JW, Kim, HI, Cheong, JH, Hyung, W, Choi, SH & Noh, SH 2016, 'Staging for Remnant Gastric Cancer: The Metastatic Lymph Node Ratio vs. the UICC 7th Edition System', Annals of Surgical Oncology, vol. 23, no. 13, pp. 4322-4331. https://doi.org/10.1245/s10434-016-5390-1

Staging for Remnant Gastric Cancer : The Metastatic Lymph Node Ratio vs. the UICC 7th Edition System. / Nakagawa, Masatoshi; Choi, Yoon Young; An, Ji Yeong; Hong, Jung Hwa; Kim, Jong Won; Kim, Hyung Il; Cheong, Jae Ho; Hyung, WooJin; Choi, Seung Ho; Noh, Sung Hoon.

In: Annals of Surgical Oncology, Vol. 23, No. 13, 01.12.2016, p. 4322-4331.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Staging for Remnant Gastric Cancer

T2 - The Metastatic Lymph Node Ratio vs. the UICC 7th Edition System

AU - Nakagawa, Masatoshi

AU - Choi, Yoon Young

AU - An, Ji Yeong

AU - Hong, Jung Hwa

AU - Kim, Jong Won

AU - Kim, Hyung Il

AU - Cheong, Jae Ho

AU - Hyung, WooJin

AU - Choi, Seung Ho

AU - Noh, Sung Hoon

PY - 2016/12/1

Y1 - 2016/12/1

N2 - Background: Unlike primary gastric cancer, a remnant gastric cancer (RGC) staging system has not been established. The retrieved lymph node counts (RLN) in RGC is generally lower than that in primary gastric cancer, so it is unclear whether positive lymph node count reflects the RGC patient’s survival. Therefore, the lymph node ratio (LR) may be more useful for RGC staging than the 7th edition UICC classification. Methods: Patients (n = 191) who underwent gastrectomy with curative intent for RGC participated in this study. LR was classified as LR = 0, 0 < LR ≤ 0.1, 0.1 < LR ≤ 0.4, and 0.4 < LR. Modified TNM staging (mTNM-LR) was established by combining the pT (7th UICC) with LR. The predictive accuracy of LR and mTNM-LR was compared with that of the pN (7th UICC) and TNM (7th UICC), respectively. Results: The mean RLN was 14.4 and that of 128 patients (67 %) was ≤15. Fifty-one patients (27 %) had metastatic lymph nodes. Multivariable analyses revealed that pT (7th UICC) (p < 0.001) and pN (7th UICC) (p = 0.001), but not LR, were independent risk factors for overall survival. The overall c-index (95 % confidence interval) of each staging system was as follows: pN (7th UICC): 0.700 (0.627–0.771); LR: 0.701 (0.627–0.775), TNM (7th UICC): 0.808 (0.761–0.870); mTNM-LR: 0.807 (0.737–0.871). There were no significant differences in the predictive accuracy between pN (7th UICC) and LR, and TNM (7th UICC) and mTNM-LR. Conclusions: LR was not superior to pN (7th UICC). Thus, the 7th edition UICC classification is a practical and reliable staging system for RGC.

AB - Background: Unlike primary gastric cancer, a remnant gastric cancer (RGC) staging system has not been established. The retrieved lymph node counts (RLN) in RGC is generally lower than that in primary gastric cancer, so it is unclear whether positive lymph node count reflects the RGC patient’s survival. Therefore, the lymph node ratio (LR) may be more useful for RGC staging than the 7th edition UICC classification. Methods: Patients (n = 191) who underwent gastrectomy with curative intent for RGC participated in this study. LR was classified as LR = 0, 0 < LR ≤ 0.1, 0.1 < LR ≤ 0.4, and 0.4 < LR. Modified TNM staging (mTNM-LR) was established by combining the pT (7th UICC) with LR. The predictive accuracy of LR and mTNM-LR was compared with that of the pN (7th UICC) and TNM (7th UICC), respectively. Results: The mean RLN was 14.4 and that of 128 patients (67 %) was ≤15. Fifty-one patients (27 %) had metastatic lymph nodes. Multivariable analyses revealed that pT (7th UICC) (p < 0.001) and pN (7th UICC) (p = 0.001), but not LR, were independent risk factors for overall survival. The overall c-index (95 % confidence interval) of each staging system was as follows: pN (7th UICC): 0.700 (0.627–0.771); LR: 0.701 (0.627–0.775), TNM (7th UICC): 0.808 (0.761–0.870); mTNM-LR: 0.807 (0.737–0.871). There were no significant differences in the predictive accuracy between pN (7th UICC) and LR, and TNM (7th UICC) and mTNM-LR. Conclusions: LR was not superior to pN (7th UICC). Thus, the 7th edition UICC classification is a practical and reliable staging system for RGC.

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