基于 CT 容积灌注成像评估胃癌淋巴管侵犯

The Evaluation of Gastric Cancer Lymphovascular Invasion Using CT Volume Perfusion.

机构信息

Medical Imaging Center, The First Affiliated Hospital of Jinan University, 510700 Guangzhou, Guangdong, China.

Department of Radiology, Jiangmen Central Hospital, 529030 Jiangmen, Guangdong, China.

出版信息

Discov Med. 2024 Oct;36(189):2037-2045. doi: 10.24976/Discov.Med.202436189.187.

DOI:10.24976/Discov.Med.202436189.187

PMID:39463223

Abstract

BACKGROUND

The best treatment option for patients with resectable gastric cancer is radical gastric cancer surgery. However, the postoperative overall survival rate is low. Lymphovascular invasion (LVI) is a risk factor for cancer recurrence and a stand-alone predictor of a poor post-operative prognosis for gastric cancer (GC) patients. Current evaluation of tumor LVI performed on histological specimens, which can only be assessed after surgery, is also limited by intra-tumoural heterogeneity via biopsy. This study explored the value of CT volume perfusion in assessing tumors' lymphovascular invasion of gastric cancer.

METHODS

59 gastric cancer patients confirmed by pathology who underwent both computed tomography (CT) volume perfusion examinations and gastrectomy surgery were prospectively included. Tumour lymphovascular invasion (LVI, positive or negative) was evaluated. The relationship between clinicopathological variables associated with LVI and CT perfusion parameters was analyzed by univariate analysis, followed by multivariate logistic regression analysis and receiver operating characteristic (ROC) analysis.

RESULTS

The LVI-positive and LVI-negative groups differed significantly in terms of time to start (TTS), mean transit time (MTT), Tmax, and flow extraction product (FEP). Both FEP (odds ratio (OR), 1.048; 95% confidence interval (CI): 1.005-1.092) and MTT (OR, 0.549; 95% CI: 0.351-0.858) have the potential to be employed as independent predictors of LVI (both < 0.05). There were different correlations between LVI, lower MTT and greater FEP. The specificity of MTT (87.88%) was higher than that of FEP (72.73%), while the sensitivity of MTT (53.85%) was lower than that of FEP (57.69%). Compared to MTT and FEP alone, the combination demonstrated a comparatively higher area under the curve (AUC) (0.797) and sensitivity (84.62%).

CONCLUSIONS

CT volume perfusion helps evaluate LVI in gastric cancer before surgery. MTT and FEP are independent predictors for LVI, and the combination variation has better diagnostic performance. Clinical Trial Register: Jiangmen Central Hospital, https://www.chictr.org.cn/showproj.html?proj=24375, ChiCTR1800014455.

摘要

背景

可切除胃癌患者的最佳治疗选择是根治性胃癌手术。然而，术后总生存率仍然较低。淋巴血管侵犯（LVI）是癌症复发的危险因素，也是胃癌（GC）患者术后预后不良的独立预测因素。目前，肿瘤 LVI 的评估是在手术后通过组织学标本进行的，这也受到活检的肿瘤内异质性的限制。本研究探讨了 CT 容积灌注在评估胃癌肿瘤淋巴管侵犯中的价值。

方法

前瞻性纳入 59 例经病理证实的胃癌患者，均行 CT 容积灌注检查和胃切除术。评估肿瘤淋巴管侵犯（LVI，阳性或阴性）。通过单因素分析、多因素 logistic 回归分析和受试者工作特征（ROC）分析，分析与 LVI 相关的临床病理变量与 CT 灌注参数之间的关系。

结果

LVI 阳性组和 LVI 阴性组在开始时间（TTS）、平均通过时间（MTT）、Tmax 和流量提取产物（FEP）方面差异有统计学意义。FEP（比值比（OR），1.048；95%置信区间（CI）：1.005-1.092）和 MTT（OR，0.549；95%CI：0.351-0.858）均有潜力成为 LVI 的独立预测因子（均<0.05）。LVI 与较低的 MTT 和较大的 FEP 之间存在不同的相关性。MTT 的特异性（87.88%）高于 FEP（72.73%），而 MTT 的敏感性（53.85%）低于 FEP（57.69%）。与 MTT 和 FEP 单独相比，联合检测具有更高的曲线下面积（AUC）（0.797）和敏感性（84.62%）。