Different prognostic effect of lymph node metastasis between remnant gastric cancers and primary proximal gastric cancers.

BACKGROUND: Although the dissected lymph node number in remnant gastric cancer (RGC) may be smaller than in primary proximal gastric cancer (PGC), altered lymphatic flow provides different metastatic patterns in lymph nodes, which could potentially give rise to prognostic differences between RGC and PGC with nodal metastasis. METHODS: Between 1993 and 2020, 2546 consecutive patients with gastric cancer underwent gastrectomy. Of these, 53 patients with RGC and 381 patients with PGC with pathologic TNM stage I-III gastric cancer underwent curative gastrectomy. We reviewed their hospital records retrospectively. RESULTS: The number of dissected lymph nodes was significantly smaller in patients with RGC than in patients with PGC (P < .001; RGC, 13.0 vs PGC, 34.5). Although the 5-year overall survival (OS) rate did not differ between RGC and PGC in all patients, the prognosis in each pathologic N (pN) stage of RGC was worse than that of PGC, suggesting that each lymph node metastasis has a greater prognostic effect in RGC. In particular, even with patients with pN1 (20.0%) or pN2 RGC (40.0%), their 5-year OS rates were poor and similar to those of patients with pN3 PGC (35.7%). The presence of lymph node metastasis in RGC (hazard ratio [HR], 4.41; 95% CI, 1.02-18.9; P = .045) was an independent and a similar prognostic impact in pN3 PGC (HR, 2.82; 95% CI, 1.57-5.07; P < .001). Lymph node metastasis in RGC more strongly affected peritoneal or lymph node recurrence rather than hematogenous recurrence. CONCLUSION: The presence of lymph node metastasis yielded a poorer prognosis in patients with RGC than patients with primary PGC. Patients with RGC with lymph node metastasis should be specifically targeted in an effort to improve their prognosis.

Lymph Node Ratio Is an Independent Prognostic Factor for Patients with Siewert Type II Adenocarcinoma of Esophagogastric Junction: Results from a 10-Year Follow-up Study.

PURPOSE: Emerging evidences suggest that lymph node ratio (LNR), the number of metastatic lymph node (LN) to the total number of dissected lymph nodes (NDLN), may predict survival in multiple types of solid tumor. However, the prognostic role of LNR in adenocarcinoma of the esophagogastric junction (AEG) remains uninvestigated. The present study is intended to determine the prognostic value of LNR in the patients with Siewert type II AEG. METHODS: A total of 342 patients with Siewert type II AEG who underwent R0 resection were enrolled in this study. The optimal cutoff of LNR was stratified into tertiles using X-tile software. The log-rank test was used to evaluate the survival differences, and multivariate Cox regression analyses were performed to determine the independent prognostic variables. RESULTS: The optimal cutoff of LNR were classified as LNR = 0, LNR between 0.01 and 0.40, and LNR > 0.41. Patients with high LNR had a shorter 5- and 10-year disease-specific survival (DSS) rate (8.5%, 1.4%) compared with those with moderate LNR (20.4%, 4.9%) and low LNR (58.0%, 27.5%) (P < 0.001). Multivariate Cox regression analysis indicated that LNR was an independent factor for DSS after adjusting for confounding variables (P < 0.05). Furthermore, after stratification by NDLN between NDLN < 15 group and NDLN ≥ 15 group, the LNR remained a significant predictor for DSS (P < 0.05). CONCLUSIONS: LNR is an independent predictor for DSS in patients with Siewert type II AEG regardless of NDLN. Patients with higher LNR have significantly shorter DSS.