Yan Chao, Zhu Zheng-gang, Yan Min, Chen Ke-min, Chen Jun, Xiang Ming, Chen Ming-min, Liu Bing-ya, Yin Hao-ran, Lin Yan-zhen
Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai Institute of Digestive Surgery, Shanghai, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2010 Feb;13(2):106-10.
To investigate the value of multidetector-row computed tomography (MDCT) in preoperatively predicting peritoneal metastasis of gastric cancer and to evaluate the indication for laparoscopic staging of gastric cancer on the basis of MDCT features.
Six hundred and forty gastric cancer patients underwent preoperative MDCT examination, and the results of MDCT were compared with surgical and pathological findings. In addition, the relationship between MDCT features (depth of invasion, lymph node metastasis status, tumor size, and thickness of tumor) and peritoneal metastasis of gastric cancer was analyzed.
The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of MDCT in predicting peritoneal metastasis of gastric cancer were 51.0% (25/49), 99.3% (587/591), 86.2% (25/29), 96.1% (587/611), and 95.6% (612/640), respectively. Univariable analysis showed that all the four MDCT features (depth of invasion, lymph node metastasis status, tumor size, and tumor thickness) of gastric cancer were significantly correlated with the peritoneal metastasis of gastric cancer. None of the patients diagnosed with stage T(0~2)N(x)M(0) or T(x)N(0)M(0) gastric cancer by MDCT were found to have peritoneal metastasis. Receiver operating characteristic (ROC) analysis showed that the accuracy of the tumor size and thickness of gastric cancer in determining peritoneal metastasis was high(area under ROC curve was 0.83 and 0.75, respectively). Multivariable analysis showed that only tumor size was significantly correlated with the peritoneal metastasis from gastric cancer.
The clinical value of MDCT in preoperative prediction of peritoneal metastasis from gastric cancer is favorable. Laparoscopy can be avoided in patients with small tumor size or stage T(0~2)N(x)M(0) or T(x)N(0)M(0) gastric cancer diagnosed by MDCT due to lower incidence of peritoneal metastasis.
探讨多排螺旋计算机断层扫描（MDCT）在术前预测胃癌腹膜转移中的价值，并根据MDCT特征评估胃癌腹腔镜分期的指征。
640例胃癌患者术前行MDCT检查，将MDCT结果与手术及病理结果进行比较。此外，分析MDCT特征（浸润深度、淋巴结转移状况、肿瘤大小及肿瘤厚度）与胃癌腹膜转移的关系。
MDCT预测胃癌腹膜转移的灵敏度、特异度、阳性预测值、阴性预测值及准确度分别为51.0%（25/49）、99.3%（587/591）、86.2%（25/29）、96.1%（587/611）及95.6%（612/640）。单因素分析显示，胃癌的4项MDCT特征（浸润深度、淋巴结转移状况、肿瘤大小及肿瘤厚度）均与胃癌腹膜转移显著相关。MDCT诊断为T(0~2)N(x)M(0)期或T(x)N(0)M(0)期胃癌的患者均未发现腹膜转移。受试者工作特征（ROC）分析显示，胃癌肿瘤大小及厚度判断腹膜转移的准确度较高（ROC曲线下面积分别为0.83和0.75）。多因素分析显示，仅肿瘤大小与胃癌腹膜转移显著相关。
MDCT术前预测胃癌腹膜转移具有良好的临床价值。对于MDCT诊断为肿瘤较小或T(0~2)N(x)M(0)期或T(x)N(0)M(0)期胃癌的患者，由于腹膜转移发生率较低，可避免行腹腔镜检查。
