Positive lymph node ratio is an index in predicting prognosis for remnant gastric cancer with insufficient retrieved lymph node in R0 resection

Wang, Honghu; Qin, Hao; Liu, Xiaofang; Gao, Zhiqiang; Hidasa, Iko; Aikebaier, Ailixier; Li, Kai

doi:10.1038/s41598-021-81663-0

Cited by 13 publications

(10 citation statements)

References 22 publications

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“…Some research has demonstrated that the lymph node ratio (LNR) has significant prognostic value for patients with CRS[ 28 ]. When the retrieved lymph node count is < 15, the LNR is superior to pN as an important and independent prognostic index of CRS[ 29 ]. In spite of the obvious postoperative short-term advantages shown by 3DLAG, the long-term survival results were similar between the 3DLAG and OG groups with the 1-year and 3-year OS rates comparable between the two groups.…”

Section: Discussionmentioning

confidence: 99%

3D laparoscopic-assisted vs open gastrectomy for carcinoma in the remnant stomach: A retrospective cohort study

Wu¹,

Song²,

Li³

et al. 2022

WJGS

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BACKGROUND Three-dimensional (3D) laparoscopic technique has gradually been applied to the treatment of carcinoma in the remnant stomach (CRS), but its clinical efficacy remains controversial. AIM To compare the short-term and long-term results of 3D laparoscopic-assisted gastrectomy (3DLAG) with open gastrectomy (OG) for CRS. METHODS The clinical data of patients diagnosed with CRS and admitted to the First Medical Center of Chinese PLA General Hospital from January 2016 to January 2021 were retrospectively collected. A total of 84 patients who met the inclusion and exclusion criteria were enrolled. All their clinical data were collected and a database was established. All patients were treated with 3DLAG or OG by experienced surgeons and were divided into two groups based on the different surgical methods mentioned above. By using outpatient and telephone follow-up, we were able to determine postoperative survival and tumor status. The postoperative short-term efficacy and 1-year and 3-year overall survival (OS) rates were compared between the two groups. RESULTS Among 84 patients with CRS, 48 were treated with OG and 36 with 3DLAG. All patients successfully completed surgery. There was no significant difference between the two groups in terms of age, gender, body mass index, ASA score, initial disease state (benign or malignant), primary surgical anastomosis method, interval time of carcinogenesis, and tumorigenesis site. Patients in the 3DLAG group experienced less intraoperative blood loss (188.33 ± 191.35 mL vs 305.83 ± 303.66 mL; P = 0.045) and smaller incision (10.86 ± 3.18 cm vs 20.06 ± 5.17 cm; P < 0.001) than those in the OG group. 3DLAGC was a more minimally invasive method. 3DLAGC retrieved significantly more lymph nodes than OG (14.0 ± 7.17 vs 10.73 ± 6.82; P = 0.036), whereas the number of positive lymph nodes did not differ between the two groups (1.56 ± 2.84 vs 2.35 ± 5.28; P = 0.413). The complication rate (8.3% vs 20.8%; P = 0.207) and intensive care unit admission rate (5.6% vs 14.5%; P = 0.372) were equivalent between the two groups. In terms of postoperative recovery, the 3DLAGC group had a lower visual analog score, shorter indwelling time of gastric and drainage tubes, shorter time of early off-bed motivation, shorter time of postoperative initial flatus and initial soft diet intake, shorter postoperative hospital stay and total hospital stay, and there were significant differences, showing better short-term efficacy. The 1-year and 3-year OS rates of OG group were 83.2% [95% confidence interval (CI): 72.4%-95.6%] and 73.3% (95%CI: 60.0%-89.5%) respectively. The 1-year...

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Section: Discussionmentioning

confidence: 99%

3D laparoscopic-assisted vs open gastrectomy for carcinoma in the remnant stomach: A retrospective cohort study

Wu¹,

Song²,

Li³

et al. 2022

WJGS

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“…Therefore, especially in advanced RGC cases with Billroth II (B-II) and Roux-en-Y (R-Y) reconstruction, jejunal LN dissection should be considered. 4,23,24 However, we presume that completion gastrectomy for RGC always needs R-Y reconstruction. We must preserve small bowel bloodstream as much as possible.…”

Section: Discussionmentioning

confidence: 99%

“…In the analysis for only advanced tumour cases, the incidence of LN metastasis was 17.6% (9/51 cases) and the LN dissection index was 7.6, which is a substantial amount. Therefore, especially in advanced RGC cases with Billroth II (B‐II) and Roux‐en‐Y (R‐Y) reconstruction, jejunal LN dissection should be considered 4,23,24 . However, we presume that completion gastrectomy for RGC always needs R‐Y reconstruction.…”

Section: Discussionmentioning

confidence: 99%

Evaluating the optimal treatment strategy for early and advanced remnant gastric cancer

Hayashi

Fujita

Matsushita

2022

ANZ Journal of Surgery

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Background This study assessed lymph node metastasis characteristics to investigate the optimal treatment strategy for early and advanced remnant gastric cancer (RGC). Methods Cases of completion gastrectomy for RGC were enrolled. The frequency of lymph node metastasis was investigated, and risk factors for metastasis were identified. The clinical significance of completion gastrectomy in early remnant gastric carcinoma cases was also examined. In advanced cases, 3‐year survival was analysed to investigate the prognostic importance of lymph node dissection and splenectomy. Results Seventy‐nine patients were included. Lymphatic invasion and pathological tumour depth were identified as risk factors for lymph node metastasis. There was no metastasis in the pT1 cases. In advanced cases, the incidence of lymph node #10 and jejunal lymph node metastasis was 8.3–10.0% and 17.6%, respectively. Prognosis was found to be unrelated with splenectomy. Conclusions Lymphatic invasion and pathological T status were identified as risk factors for LN metastasis in RGC. Additional gastrectomy after ESD might not be mandatory for early RGC cases. For advanced RGC cases, splenectomy might not improve patient prognosis, however, lymph node dissection of jejunal and #10 lymph nodes should be considered due to its high incidence of metastasis.

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“…The presence of positive lymph nodes is a well-known poor prognostic factor for solid cancers, including GC. 1,4,5,28,29 CA-125 is also associated with the prognosis of GC. 30,31 According to the WHO 2019 classification, 32 some of the selected changes in the new classification of GC-related digestive system tumors are microsatellite instability high (MSI-H) and Epstein-Barr virus (EBV) positivity, which are good prognostic markers with potential therapeutic importance that can be used in future radiomic studies.…”

Section: Discussionmentioning

confidence: 99%

Radiomics signature for predicting postoperative disease-free survival of patients with gastric cancer: development and validation of a predictive nomogram

Hu¹,

Zhongchang²,

Zhou³

et al. 2022

Diagn Interv Radiol

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Radiomics can be used to determine the prognosis of gastric cancer (GC). The objective of this study was to predict the disease-free survival (DFS) after GC surgery based on computed tomography-enhanced images combined with clinical features. METHODSClinical, imaging, and pathological data of patients who underwent gastric adenocarcinoma resection from June 2015 to May 2019 were retrospectively analyzed. The primary outcome was DFS. Radiomics features were selected using Least Absolute Shrinkage and Selection Operator algorithm and converted into the Rad-score. A nomogram was constructed based on the Radscore and other clinical factors. The Rad-score and nomogram were validated in the training and validation groups. RESULTSTotally, 179 patients were randomly divided into the training (n = 124) and validation (n = 55) groups. In the training group, validation group, and overall population, the Rad-score could be divided into categories indicating low, moderate, and high risk of recurrence, metastasis, or death; all risk categories showed a significant difference between the training, validation, and overall population groups (all P < .001). Positive lymph nodes (hazard ratio (HR) = 3.07, 95% CI: 1.52-6.23, P = .002), cancer antigen-125 (HR = 3.24, 95% CI: 1.54-6.80, P = .002), and the Radscore (HR = 0.73, 95% CI: 0.61-0.87, P < .001) were independently associated with DFS. These 3 variables were used to construct a nomogram. In the training group, the areas under the curve at 3 years were 0.758 and 0.776 for the Rad-score and the nomogram, respectively, while they were both 1.000 in the validation group. The net benefit rate was analyzed using a decision curve in the training and validation groups, and the nomogram was superior to the single Rad-score. CONCLUSIONRad-score is an independent factor for DFS after gastrectomy for GC. The nomogram established in this study could be an effective tool for the clinical prediction of DFS after gastrectomy. G astric adenocarcinomas are the most common type of stomach cancer. 1,2 There are 1 033 701 new gastric cancer (GC) cases and 872 685 GC-related deaths worldwide in 2018. 3 Some regions including Eastern Asia, Eastern Europe, and South America have the highest incidence of GC. 2,4 The treatment management of GC includes surgery, chemotherapy, radiation therapy, and targeted therapy. 1,4,5 The 5-year survival of GC patients with localized, regional, and distant-stage diseases are 67%, 31%, and 5%, respectively. 1,4,5 The classical prognostic factors for GC include tumor size, lymphovascular invasion, nodal involvement, positive peritoneal cytology, signet ring cell adenocarcinoma, 1,2,4 age, sex, 6 and obesity. 7,8 TNM (T: primary tumor, N: lymph node, M: distant metastasis) staging system and histopathological classification have been widely used as the prognostic tools for GC, which can help to formulate the treatment strategy. 1,4,5 However, their predictive ability remains limited. 9-11 Novel prognostic biomarkers are also being explored, with similar restrictions. [...

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Positive lymph node ratio is an index in predicting prognosis for remnant gastric cancer with insufficient retrieved lymph node in R0 resection

Cited by 13 publications

References 22 publications

3D laparoscopic-assisted vs open gastrectomy for carcinoma in the remnant stomach: A retrospective cohort study

3D laparoscopic-assisted vs open gastrectomy for carcinoma in the remnant stomach: A retrospective cohort study

Evaluating the optimal treatment strategy for early and advanced remnant gastric cancer

Radiomics signature for predicting postoperative disease-free survival of patients with gastric cancer: development and validation of a predictive nomogram

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