Liu Yiyang, Chen Yusong, Shu Jiao, Zhang Zhe, You Yaru, Yue Songwei, Ji Qingyu, Chen Kuisheng, Liu Yao, Duan Bo, Yu Baiqing, Kou Songzi, Pang Xia, Wang Weitao, Yang Li, Zhao Zihao, Gao Jianbo
Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China; Henan International Joint Laboratory of Medical Imaging, Zhengzhou, China; Henan Key Laboratory of Image Diagnosis and Treatment for Digestive System Tumor, Zhengzhou, China; Henan Key Laboratory of CT Imaging, Zhengzhou, China; The First Clinical School of Medicine, Zhengzhou University, Zhengzhou, 450052, China.
The First Clinical School of Medicine, Zhengzhou University, Zhengzhou, 450052, China; Department of Pathology, The First Affiliated Hospital of Zhengzhou University, China.
Eur J Surg Oncol. 2025 Aug;51(8):110017. doi: 10.1016/j.ejso.2025.110017. Epub 2025 Apr 4.
To investigate preoperative dual-energy CT (DECT)-derived independent risk factors affecting progression-free survival (PFS) in patients with locally advanced gastric cancer (LAGC) undergoing gastrectomy, and to reveal the underlying histopathologic changes.
This prospective study included patients who underwent preoperative DECT scan and gastrectomy. Clinical data, DECT-derived morphological characteristics and iodine-related parameters were comprehensively collected. Univariate and multivariate analyses were carried out to identify independent risk factors associated with PFS. The prognostic performance of various parameters was evaluated using the bootstrap-based consistency index (C-index) and time-dependent receiver operating characteristic (ROC) analysis. Kaplan-Meier curves were used to assess the differences in survival analysis. The histopathologic underpinnings of the DECT-based combined parameter for evaluating PFS were explored.
120 LAGC patients (63.3 ± 10.9 years; 94 men) were analyzed. Age, arterial enhancement fraction (AEF), serosal invasion, and tumor thickness were identified as preoperative independent risk factors affecting PFS (all p < 0.05). The combined parameters based on these risk factors achieved a C-index of 0.75, significantly or slightly superior to that of any single risk factor (all p < 0.05) or postoperative pathological staging (C-index, 0.67; p > 0.05). For predicting the 0.5-, 1- and 2-year PFS, the combined parameter had an area-under-the-curve (AUC) of 0.72, 0.77, and 0.74, respectively. PFS significantly differed between patients of high- and low-risks assessed with the combined parameter (p < 0.001). Histopathologically, the combined parameter was associated with tumor microvessel density (r = 0.31, p < 0.001).
The combination of DECT-derived morphological characteristics, iodine-related parameters, and clinical data helped accurately stratify PFS in LAGC before surgery and is associated with tumor angiogenesis.
Dual-energy CT was promising in the preoperative evaluation of the progression-free survival in LAGC patients after gastrectomy.
探讨术前双能CT（DECT）得出的影响接受胃切除术的局部晚期胃癌（LAGC）患者无进展生存期（PFS）的独立危险因素，并揭示其潜在的组织病理学变化。
这项前瞻性研究纳入了接受术前DECT扫描和胃切除术的患者。全面收集临床数据、DECT得出的形态学特征和碘相关参数。进行单因素和多因素分析以确定与PFS相关的独立危险因素。使用基于自抽样法的一致性指数（C指数）和时间依赖性受试者工作特征（ROC）分析评估各种参数的预后性能。采用Kaplan-Meier曲线评估生存分析中的差异。探讨基于DECT的评估PFS的联合参数的组织病理学基础。
分析了120例LAGC患者（63.3±10.9岁；94例男性）。年龄、动脉强化分数（AEF）、浆膜侵犯和肿瘤厚度被确定为影响PFS的术前独立危险因素（均p<0.05）。基于这些危险因素的联合参数的C指数为0.75，显著或略优于任何单一危险因素（均p<0.05）或术后病理分期（C指数，0.67；p>0.05）。对于预测0.5年、1年和2年的PFS，联合参数的曲线下面积（AUC）分别为0.72、0.77和0.74。根据联合参数评估的高风险和低风险患者的PFS有显著差异（p<0.001）。组织病理学上，联合参数与肿瘤微血管密度相关（r=0.31，p<0.001）。
DECT得出的形态学特征、碘相关参数和临床数据的组合有助于在术前准确分层LAGC患者的PFS，且与肿瘤血管生成相关。
双能CT在胃切除术后LAGC患者无进展生存期的术前评估中具有前景。
