Zhang Hao-Yu, Aimaiti Muerzhate, Bai Long, Yuan Meng-Qing, Zhu Chun-Chao, Yan Jia-Jun, Cai Jian-Hua, Dong Zhong-Yi, Zhang Zi-Zhen
Department of Gastrointestinal Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
The Hongkong University of Science and Technology, Hongkong, China.
Abdom Radiol (NY). 2025 Feb;50(2):608-618. doi: 10.1007/s00261-024-04537-9. Epub 2024 Sep 3.
The expansion of function-preserving surgery became possible due to a more profound understanding of gastric cancer (GC), and T1N + or T2N + gastric cancer patients might be potential beneficiaries. However, ways to evaluate the possibility of function-preserving pylorus surgery are still unknown.
A total of 288 patients at Renji Hospital and 58 patients at Huadong Hospital, pathologically diagnosed with gastric cancer staging at T1 and T2 with tumors located in the upper two-thirds of the stomach, were retrospectively enrolled from March 2015 to October 2022. Tumor regions of interest (ROIs) were manually delineated on bi-phase CT images, and a nomogram was built and evaluated.
The radiomic features distributed differently between positive and negative pLNm groups. Two radiomic signatures (RS1 and RS2) and one clinical signature were constructed. The radiomic signatures exhibited good performance for discriminating pLNm status in the test set. The three signatures were then combined into an integrated nomogram (IN). The IN showed good discrimination of pLNm in the Renji cohort (AUC 0.918) and the Huadong cohort (AUC 0.649). The verification models showed high values.
For GC patients with T1 and T2 tumors located in the upper two-thirds of the stomach, a nomogram was successfully built for predicting pylorus lymph node metastasis, which would guide the surgical indication extension of conservative gastrectomies.
由于对胃癌（GC）有了更深入的了解，保留功能手术的扩展成为可能，T1N+或T2N+胃癌患者可能是潜在受益者。然而，评估保留幽门手术可能性的方法仍然未知。
回顾性纳入2015年3月至2022年10月在仁济医院病理诊断为T1和T2期胃癌且肿瘤位于胃上三分之二的288例患者以及在华东医院的58例患者。在双期CT图像上手动勾勒出肿瘤感兴趣区域（ROI），并构建和评估列线图。
阳性和阴性pLNm组之间的放射组学特征分布不同。构建了两个放射组学特征（RS1和RS2）和一个临床特征。放射组学特征在测试集中对区分pLNm状态表现出良好性能。然后将这三个特征组合成一个综合列线图（IN）。IN在仁济队列（AUC 0.918）和华东队列（AUC 0.649）中对pLNm显示出良好的区分能力。验证模型显示出较高的值。
对于肿瘤位于胃上三分之二的T1和T2期GC患者，成功构建了一个用于预测幽门淋巴结转移的列线图，这将指导保守性胃切除术手术指征的扩展。
