Resectable Remnant Gastric Cancer: Worse Prognosis or Unsuitable Stage Classification System? A Retrospective Propensity Score Matching Analysis

Abstract Purpose: Currently, the characteristics, and prognosis of remnant gastric cancer (RGC) were not fully understood yet. The present study aimed to describe the details of clinicopathological features of resectable RGC and investigated the factors affecting survival after the curative operation.Methods: From Jan. 2006 to Dec. 2015, a total of 118 resectable RGC patients (the RGC group) and 236 age-, sex- and TNM stages matched resectable gastric cancer (GC) patients (the control group) were recruited retrospectively. Clinicopathological characteristics and overall survival were compared between the two groups.Results: The overall survival rate was 46.61% for RGC patients compared to 55.08% for control groups (P < 0.01), and the mean overall survival time of RGC patients was 40.23 ± 32.27 months, compared with 55.06 ± 34.29 months in the control group (P = 0.023 after matching). The overall survival (OS) of RGC patients with stage IIb was much worse than IIa (P < 0.001) and similar to Ⅲa (P = 0.463) and Ⅲb (P = 0.014 ), which indicated that the current TNM classification was not suitable for the patients with RGC. Multivariate Cox proportional hazards model analysis revealed that TNM stage (HR: 3.899, P < 0.001) and metastatic lymph nodes ratio (LNR) (HR: 2.405, P = 0.028) were independent prognostic significance to OS.Conclusions: The OS of RGC was much worse than GC with similar TNM stages, which might be caused by an unsuitable TNM stage classification system for RGC. And LNR might consider a highly reliable indicator to evaluate the N status in RGC.