Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Ann Surg Oncol. 2012 Aug;19(8):2465-70. doi: 10.1245/s10434-012-2283-9. Epub 2012 Mar 7.
Thin-slice multidetector row computed tomography (MDCT) has emerged as a promising diagnostic modality in various cancers. This study was designed to evaluate the utility of metastatic nodal counts on MDCT as a surrogate maker for surgical curability in gastric cancer.
Between 2005 and 2007, a total of 92 patients with gastric cancer underwent preoperative MDCT at a slice thickness of 1.0 mm at our hospital. All regional lymph nodes showing metastatic involvement were preoperatively counted.
Although the total counts of metastatic lymph nodes on MDCT were significantly smaller than those found by histopathology (P = 0.00001), there was a significant correlation between nodal counts on MDCT and histopathology by Spearman's analysis [P < 0.0001, pathologic counts = 1.63x (counts on MDCT) + 2.5]. Nodal counts on MDCT of ≥4 were analyzed as putative pathologic nodal counts of ≥8 by the equation, and pathologic metastatic nodal counts of ≥8 were most significantly correlated with noncurative resection (P < 0.0001). According to the logistic regression analysis, nodal counts on MDCT of ≥4 were a significant independent variable for noncurative resection (P = 0.0052, odds ratio 26.68). Nodal counts on MDCT of ≥4 could distinguish noncurative patients from curative patients with 94.4% sensitivity and 71.6% specificity.
Nodal counts on MDCT could be a reliable surrogate maker for surgical curability of gastric cancer. This marker might enable us to select prospective candidates for additional or alternative treatments in gastric cancer.
薄层多排螺旋计算机断层扫描（MDCT）已成为各种癌症有前途的诊断方式。本研究旨在评估 MDCT 转移淋巴结计数作为胃癌手术可切除性的替代标志物的效用。
2005 年至 2007 年期间，我院共有 92 例胃癌患者在术前进行了 1.0mm 层厚的 MDCT。所有显示转移性受累的区域淋巴结均进行术前计数。
虽然 MDCT 上转移性淋巴结的总计数明显小于组织病理学发现的淋巴结计数（P=0.00001），但通过 Spearman 分析，MDCT 上的淋巴结计数与组织病理学之间存在显著相关性[P<0.0001，病理计数=1.63x（MDCT 计数）+2.5]。通过方程，将 MDCT 上的淋巴结计数≥4 分析为假设的病理淋巴结计数≥8，并且病理转移性淋巴结计数≥8与非治愈性切除最显著相关（P<0.0001）。根据逻辑回归分析，MDCT 上的淋巴结计数≥4 是非治愈性切除的显著独立变量（P=0.0052，优势比 26.68）。MDCT 上的淋巴结计数≥4 可以区分非治愈患者和可治愈患者，其敏感性为 94.4%，特异性为 71.6%。
MDCT 上的淋巴结计数可以作为胃癌手术可切除性的可靠替代标志物。该标志物可能使我们能够选择胃癌患者进行额外或替代治疗的前瞻性候选者。
