Positive lymph node ratio as a nodal staging system to avoid stage migration between remnant and primary proximal gastric cancers
Abstract Nodal staging of gastric cancer (GC) based on the number of positive lymph nodes (PLNs) is a robust prognostic factor. However, the number of retrieved lymph nodes in remnant GC (RGC) may be lower than in primary GC owing to variations in the extents of initial gastrectomy and lymphadenecto...
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Nature Portfolio
2025-08-01
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| Online Access: | https://doi.org/10.1038/s41598-025-13766-x |
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| author | Daiki Matsubara Shuhei Komatsu Tomoki Konishi Keiji Nishibeppu Takuma Ohashi Hirotaka Konishi Takeshi Kubota Hitoshi Fujiwara Kazuma Okamoto Eigo Otsuji Atsushi Shiozaki |
| author_facet | Daiki Matsubara Shuhei Komatsu Tomoki Konishi Keiji Nishibeppu Takuma Ohashi Hirotaka Konishi Takeshi Kubota Hitoshi Fujiwara Kazuma Okamoto Eigo Otsuji Atsushi Shiozaki |
| author_sort | Daiki Matsubara |
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| description | Abstract Nodal staging of gastric cancer (GC) based on the number of positive lymph nodes (PLNs) is a robust prognostic factor. However, the number of retrieved lymph nodes in remnant GC (RGC) may be lower than in primary GC owing to variations in the extents of initial gastrectomy and lymphadenectomy. This study evaluated stage migration between RGC and primary proximal gastric cancer (PGC) and the clinical usefulness of the PLN ratio (PLNR) in mitigating stage migration. Among 4,142 patients who underwent gastrectomy, 91 with RGC and 768 with PGC at pStage I–III were retrospectively analyzed. A PLNR of 0.3 was the best-stratified prognosis (p < 0.001). Five-year survival in pN1–3 RGC was worse than in PGC, whereas pN0 showed no prognostic difference. PLNR stratification (0, < 0.3, and ≥ 0.3) effectively distinguished prognosis in patients with RGC (82.2, 46.6, 12.7%, respectively) and PGC (88.9, 63.4, 16.4%, respectively). High PLNR (≥ 0.3) was an independent prognostic factor in RGC (HR: 2.76, 95% CI: 1.06–7.17, p = 0.036), whereas pN stage was not. Prognostic stratification was reliable with at least five dissected lymph nodes. PLNR provides effective prognostic stratification in RGC and helps evaluate stage migration between RGC and primary PGC. |
| format | Article |
| id | doaj-art-d274c2bedee342ef91607c1b55743df1 |
| institution | Kabale University |
| issn | 2045-2322 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Nature Portfolio |
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| series | Scientific Reports |
| spelling | doaj-art-d274c2bedee342ef91607c1b55743df12025-08-20T03:42:57ZengNature PortfolioScientific Reports2045-23222025-08-011511810.1038/s41598-025-13766-xPositive lymph node ratio as a nodal staging system to avoid stage migration between remnant and primary proximal gastric cancersDaiki Matsubara0Shuhei Komatsu1Tomoki Konishi2Keiji Nishibeppu3Takuma Ohashi4Hirotaka Konishi5Takeshi Kubota6Hitoshi Fujiwara7Kazuma Okamoto8Eigo Otsuji9Atsushi Shiozaki10Department of Digestive Surgery (Gastric and Esophageal Surgery Division), Kyoto First Red Cross HospitalDepartment of Digestive Surgery (Gastric and Esophageal Surgery Division), Kyoto Prefectural University of MedicineDepartment of Digestive Surgery (Gastric and Esophageal Surgery Division), Kyoto First Red Cross HospitalDepartment of Digestive Surgery (Gastric and Esophageal Surgery Division), Kyoto Prefectural University of MedicineDepartment of Digestive Surgery (Gastric and Esophageal Surgery Division), Kyoto Prefectural University of MedicineDepartment of Digestive Surgery (Gastric and Esophageal Surgery Division), Kyoto Prefectural University of MedicineDepartment of Digestive Surgery (Gastric and Esophageal Surgery Division), Kyoto Prefectural University of MedicineDepartment of Digestive Surgery (Gastric and Esophageal Surgery Division), Kyoto Prefectural University of MedicineDepartment of Digestive Surgery (Gastric and Esophageal Surgery Division), Kyoto First Red Cross HospitalDepartment of Digestive Surgery (Gastric and Esophageal Surgery Division), Kyoto First Red Cross HospitalDepartment of Digestive Surgery (Gastric and Esophageal Surgery Division), Kyoto Prefectural University of MedicineAbstract Nodal staging of gastric cancer (GC) based on the number of positive lymph nodes (PLNs) is a robust prognostic factor. However, the number of retrieved lymph nodes in remnant GC (RGC) may be lower than in primary GC owing to variations in the extents of initial gastrectomy and lymphadenectomy. This study evaluated stage migration between RGC and primary proximal gastric cancer (PGC) and the clinical usefulness of the PLN ratio (PLNR) in mitigating stage migration. Among 4,142 patients who underwent gastrectomy, 91 with RGC and 768 with PGC at pStage I–III were retrospectively analyzed. A PLNR of 0.3 was the best-stratified prognosis (p < 0.001). Five-year survival in pN1–3 RGC was worse than in PGC, whereas pN0 showed no prognostic difference. PLNR stratification (0, < 0.3, and ≥ 0.3) effectively distinguished prognosis in patients with RGC (82.2, 46.6, 12.7%, respectively) and PGC (88.9, 63.4, 16.4%, respectively). High PLNR (≥ 0.3) was an independent prognostic factor in RGC (HR: 2.76, 95% CI: 1.06–7.17, p = 0.036), whereas pN stage was not. Prognostic stratification was reliable with at least five dissected lymph nodes. PLNR provides effective prognostic stratification in RGC and helps evaluate stage migration between RGC and primary PGC.https://doi.org/10.1038/s41598-025-13766-xPositive lymph-node ratioGastric cancerRemnantProximal |
| spellingShingle | Daiki Matsubara Shuhei Komatsu Tomoki Konishi Keiji Nishibeppu Takuma Ohashi Hirotaka Konishi Takeshi Kubota Hitoshi Fujiwara Kazuma Okamoto Eigo Otsuji Atsushi Shiozaki Positive lymph node ratio as a nodal staging system to avoid stage migration between remnant and primary proximal gastric cancers Scientific Reports Positive lymph-node ratio Gastric cancer Remnant Proximal |
| title | Positive lymph node ratio as a nodal staging system to avoid stage migration between remnant and primary proximal gastric cancers |
| title_full | Positive lymph node ratio as a nodal staging system to avoid stage migration between remnant and primary proximal gastric cancers |
| title_fullStr | Positive lymph node ratio as a nodal staging system to avoid stage migration between remnant and primary proximal gastric cancers |
| title_full_unstemmed | Positive lymph node ratio as a nodal staging system to avoid stage migration between remnant and primary proximal gastric cancers |
| title_short | Positive lymph node ratio as a nodal staging system to avoid stage migration between remnant and primary proximal gastric cancers |
| title_sort | positive lymph node ratio as a nodal staging system to avoid stage migration between remnant and primary proximal gastric cancers |
| topic | Positive lymph-node ratio Gastric cancer Remnant Proximal |
| url | https://doi.org/10.1038/s41598-025-13766-x |
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