Chen Yong, Jiang Jinling, Yan Chao, Jiang Jiang, Shi Bowen, Xu Zhihan, Yuan Fei, Zhang Huan, Zhang Jun
Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Eur Radiol. 2025 Jan;35(1):93-104. doi: 10.1007/s00330-024-10737-0. Epub 2024 Jul 9.
This study examines the effectiveness of dual-energy CT (DECT) delayed-phase extracellular volume (ECV) fraction in predicting tumor regression grade (TRG) in far-advanced gastric cancer (FAGC) patients receiving preoperative immuno-chemotherapy.
A retrospective analysis was performed on far-advanced gastric adenocarcinoma patients treated with preoperative immuno-chemotherapy at our institution from August 2019 to March 2023. Patients were categorized based on their TRG into pathological complete response (pCR) and non-pCR groups. ECV was determined using the delayed-phase iodine maps. In addition, tumor iodine densities and standardized iodine ratios were meticulously analyzed using the triple-phase enhanced iodine maps. Univariate analysis with five-fold cross-validation and Spearman correlation determined DECT parameters and clinical indicators association with pCR. The predictive accuracy of these parameters for pCR was evaluated using a weighted logistic regression model with five-fold cross-validation.
Of the 88 patients enrolled (mean age 60.8 ± 11.1 years, 63 males), 21 (23.9%) achieved pCR. Univariate analysis indicated ECV's significant role in differentiating between pCR and non-pCR groups (average p value = 0.021). In the logistic regression model, ECV independently predicted pCR with an average odds ratio of 0.911 (95% confidence interval, 0.798-0.994). The model, incorporating ECV, tumor area, and ID (the relative change rate of iodine density from venous phase to arterial phase), showed an average area under curves (AUCs) of 0.780 (0.770-0.791) and 0.766 (0.731-0.800) for the training and validation sets, respectively, in predicting pCR.
DECT-derived ECV fraction is a valuable predictor of TRG in FAGC patients undergoing preoperative immuno-chemotherapy.
This study demonstrates that DECT-derived extracellular volume fraction is a reliable predictor for pathological complete response in far-advanced gastric cancer patients receiving preoperative immuno-chemotherapy, offering a noninvasive tool for identifying potential treatment beneficiaries.
本研究探讨双能CT（DECT）延迟期细胞外容积（ECV）分数在预测接受术前免疫化疗的晚期胃癌（FAGC）患者肿瘤退缩分级（TRG）方面的有效性。
对2019年8月至2023年3月在我院接受术前免疫化疗的晚期胃腺癌患者进行回顾性分析。根据TRG将患者分为病理完全缓解（pCR）组和非pCR组。使用延迟期碘图确定ECV。此外，使用三相增强碘图仔细分析肿瘤碘密度和标准化碘比率。采用五折交叉验证的单因素分析和Spearman相关性分析确定DECT参数和临床指标与pCR的关联。使用具有五折交叉验证的加权逻辑回归模型评估这些参数对pCR的预测准确性。
纳入的88例患者（平均年龄60.8±11.1岁，男性63例）中，21例（23.9%）达到pCR。单因素分析表明ECV在区分pCR组和非pCR组中具有重要作用（平均p值=0.021）。在逻辑回归模型中，ECV独立预测pCR，平均比值比为0.911（95%置信区间，0.798 - 0.994）。该模型纳入ECV、肿瘤面积和ID（碘密度从静脉期到动脉期的相对变化率），在预测pCR时，训练集和验证集的平均曲线下面积（AUC）分别为0.780（0.770 - 0.791）和0.766（0.731 - 0.800）。
DECT衍生的ECV分数是接受术前免疫化疗的FAGC患者TRG的有价值预测指标。
本研究表明，DECT衍生的细胞外容积分数是接受术前免疫化疗的晚期胃癌患者病理完全缓解的可靠预测指标，为识别潜在治疗受益者提供了一种非侵入性工具。
