Annals of Surgical Oncology

, Volume 23, Issue 13, pp 4322–4331 | Cite as

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

  • Masatoshi Nakagawa
  • Yoon Young Choi
  • Ji Yeong AnEmail author
  • Jung Hwa Hong
  • Jong Won Kim
  • Hyung-Il Kim
  • Jae-Ho Cheong
  • Woo Jin Hyung
  • Seung Ho Choi
  • Sung Hoon Noh
Gastrointestinal Oncology



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.


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.


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.


LR was not superior to pN (7th UICC). Thus, the 7th edition UICC classification is a practical and reliable staging system for RGC.


Staging System National Comprehensive Cancer Network Tumor Node Metastasis Tumor Node Metastasis Staging Retrieve Lymph Node 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



This research was supported by a grant of the National R&D Program for Cancer Control, Ministry of Health and Welfare, Republic of Korea (1020390, 1320360).

Conflict of Interest

The authors declare that they have no conflict of interest or financial ties to disclose.

Supplementary material

10434_2016_5390_MOESM1_ESM.docx (39 kb)
Supplementary material 1 (DOCX 38 kb)
10434_2016_5390_MOESM2_ESM.tif (226 kb)
Kaplan-Meier curves comparing the groups with retrieved lymph node counts ≤ 15 and > 15 in N0 (A), N1 (B), N2 (C), and N3 (D) according to pN (7th UICC). RLN: retrieved lymph node counts, UICC: Union of International Cancer Control (TIFF 226 kb)
10434_2016_5390_MOESM3_ESM.tif (201 kb)
Kaplan-Meier curves comparing the groups with retrieved lymph node counts ≤ 15 and > 15 in 0<LR≤0.1 (A), 0.1<LR≤0.4 (B), and 0.4<LR (C). LR: lymph node metastatic ratio, RLN: retrieved lymph node counts (TIFF 201 kb)


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Copyright information

© Society of Surgical Oncology 2016

Authors and Affiliations

  • Masatoshi Nakagawa
    • 1
    • 2
  • Yoon Young Choi
    • 1
  • Ji Yeong An
    • 3
    Email author
  • Jung Hwa Hong
    • 4
  • Jong Won Kim
    • 1
  • Hyung-Il Kim
    • 1
  • Jae-Ho Cheong
    • 1
    • 5
  • Woo Jin Hyung
    • 1
  • Seung Ho Choi
    • 1
  • Sung Hoon Noh
    • 1
    • 5
  1. 1.Department of SurgeryYonsei University Health System, Yonsei University College of MedicineSeoulRepublic of Korea
  2. 2.Department of Gastric SurgeryTokyo Medical and Dental UniversityTokyoJapan
  3. 3.Department of SurgeryGastric Cancer Center, Samsung Medical Center, Sungkyunkwan University School of MedicineSeoulKorea
  4. 4.Biostatistics Collaboration UnitYonsei University Health System, Yonsei University College of MedicineSeoulRepublic of Korea
  5. 5.Brain Korea 21 PLUS Project for Medical ScienceYonsei University Health System, Yonsei University College of MedicineSeoulRepublic of Korea

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