Song Bong-Il
Department of Nuclear Medicine, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu 42601, South Korea.
World J Gastrointest Oncol. 2020 Apr 15;12(4):447-456. doi: 10.4251/wjgo.v12.i4.447.
Lymph node (LN) metastasis is an important prognostic factor in patients with gastric cancer (GC). However, the evaluation of LN metastasis status in the preoperative setting is not accurate. Therefore, precise preoperative prediction of LN metastasis status is crucial for optimal treatment in patients with GC.
To develop a preoperative nomogram for LN metastasis using F-18 fluorodeoxyglucose (F-18 FDG) positron emission tomography/computed tomography (PET/CT) and preoperative laboratory test findings in GC.
In this study, the data of 566 GC patients who underwent preoperative F-18 FDG PET/CT and subsequent surgical resection were analyzed. The LN metastasis prediction model was developed in the training cohort and validated in the internal validation cohort. Routine preoperative laboratory tests, including albumin and carbohydrate antigen (CA) 19-9 were performed in all patients. Univariate and multivariable logistic regression was performed to validate the preoperative predictive indicators for LN metastasis.
Of the 566 patients, 232 (41%) had confirmed histopathologic LN metastasis. Univariate logistic regression revealed that the tumor location, blood hemoglobin, serum albumin levels, neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, CA 19-9, maximum standardized uptake value (SUVmax) of the primary tumor (T_SUVmax), and SUVmax of LN (N_SUVmax) were significantly associated with LN metastasis. In multivariate analysis, T_SUVmax (OR = 1.08; 95%CI: 1.02-1.15; = 0.011) and N_SUVmax (OR = 1.49; 95%CI: 1.19-1.97; = 0.002) were found to be significant predictive factors for LN metastasis. The LN metastasis prediction model using T_SUVmax, N_SUVmax, serum albumin, and CA 19-9 yielded an area under the curve (AUC) of 0.733 (95%CI: 0.683-0.784, = 0.025) in the training cohort and AUC of 0.756 (95%CI: 0.678-0.833, < 0.001) in the test cohort.
T_SUVmax and N_SUVmax measured by preoperative F-18 FDG PET/CT are independent predictive factors for LN metastasis in GC.
淋巴结（LN）转移是胃癌（GC）患者的一个重要预后因素。然而，术前对LN转移状态的评估并不准确。因此，准确术前预测LN转移状态对于GC患者的最佳治疗至关重要。
利用F-18氟脱氧葡萄糖（F-18 FDG）正电子发射断层扫描/计算机断层扫描（PET/CT）及术前实验室检查结果，建立GC患者LN转移的术前列线图。
本研究分析了566例行术前F-18 FDG PET/CT及后续手术切除的GC患者的数据。在训练队列中建立LN转移预测模型，并在内部验证队列中进行验证。所有患者均进行常规术前实验室检查，包括白蛋白和糖类抗原（CA）19-9。进行单因素和多因素逻辑回归以验证LN转移的术前预测指标。
566例患者中，232例（41%）经组织病理学证实有LN转移。单因素逻辑回归显示，肿瘤位置、血红蛋白、血清白蛋白水平、中性粒细胞与淋巴细胞比值、血小板与淋巴细胞比值、CA 19-9、原发肿瘤最大标准化摄取值（SUVmax）（T_SUVmax）及LN的SUVmax（N_SUVmax）与LN转移显著相关。多因素分析发现，T_SUVmax（OR = 1.08；95%CI：1.02-1.15；P = 0.011）和N_SUVmax（OR = 1.49；95%CI：1.19-1.97；P = 0.002）是LN转移的显著预测因素。使用T_SUVmax、N_SUVmax、血清白蛋白和CA 19-9的LN转移预测模型在训练队列中的曲线下面积（AUC）为0.733（95%CI：0.683-0.784，P = 0.025），在测试队列中的AUC为0.756（95%CI：0.678-0.833，P < 0.001）。
术前F-18 FDG PET/CT测量的T_SUVmax和N_SUVmax是GC患者LN转移的独立预测因素。
