Dai Di, Bao Zhengyuan, Zhu Yinsu, Wang Meiqin
Department of Radiology, The Affiliated Cancer Hospital of Nanjing Medical University, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing, China.
Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
J Gastrointest Oncol. 2025 Jun 30;16(3):865-874. doi: 10.21037/jgo-2025-82. Epub 2025 Jun 26.
Body compositions were associated with the clinical outcomes of patients with malignant tumors. Our study aimed to explore the predictive value of preoperative body compositions for liver metastasis after radical gastrectomy in gastric cancer (GC).
GC patients undergoing radical gastrectomy in the single center from January 2012 to December 2023 were retrospectively included. Patients with distant metastases or other malignant tumors before the surgery were excluded. Included patients were divided into the liver metastasis and control groups according to the presence of liver metastasis within the 3-year follow-up. Body compositions including skeletal muscle (SM), visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and intramuscular adipose tissue (IAT) were estimated using preoperative computed tomography (CT) images at the L3 level. Multivariate logistic regression analysis was used to identify the independent risk factors of liver metastasis. Receiver operating characteristic curve was used to evaluate the predictive performance of significant factors.
A total of 300 patients were included for the final analysis with 223 in the control group and 77 in the liver metastasis group. Compared with the control group, the liver metastasis group contained more males (P<0.001), presented older age (P=0.004), higher T and N stages (P<0.001 for both), higher incidence of moderately-poorly and poorly differentiated cell grade (P<0.001), increased lymphovascular and perineural invasions (P<0.001 and P=0.01, respectively), higher incidence of abnormal carcinoembryonic antigen (CEA), carbohydrate antigen 199 (CA199) and alpha-fetoprotein (AFP) (P=0.01, 0.01 and 0.003, respectively), smaller SAT area (SATA) (P=0.009) and larger IAT area (IATA) (P=0.002). Multivariate logistic regression analysis demonstrated that the N stage (P=0.03), cell grade (P=0.01), AFP (P=0.04), and IATA (P=0.04) were independent risk factors for liver metastasis. The combination of SATA and IATA exhibited good predictive performance for liver metastasis [area under the curve (AUC) =0.687, 95% confidence interval (CI): 0.621-0.754].
The preoperative SATA and IATA at the L3 level were significant predictors of postoperative liver metastasis in GC patients undergoing radical gastrectomy.
身体组成与恶性肿瘤患者的临床结局相关。我们的研究旨在探讨术前身体组成对胃癌（GC）根治性胃切除术后肝转移的预测价值。
回顾性纳入2012年1月至2023年12月在单中心接受根治性胃切除的GC患者。排除术前有远处转移或其他恶性肿瘤的患者。根据3年随访期间是否存在肝转移，将纳入的患者分为肝转移组和对照组。使用术前L3水平的计算机断层扫描（CT）图像评估包括骨骼肌（SM）、内脏脂肪组织（VAT）、皮下脂肪组织（SAT）和肌内脂肪组织（IAT）在内的身体组成。采用多因素逻辑回归分析确定肝转移的独立危险因素。使用受试者工作特征曲线评估显著因素的预测性能。
共纳入300例患者进行最终分析，其中对照组223例，肝转移组77例。与对照组相比，肝转移组男性更多（P<0.001），年龄更大（P=0.004），T和N分期更高（两者均P<0.001），中低分化和低分化细胞分级的发生率更高（P<0.001），淋巴管和神经周围侵犯增加（分别为P<0.001和P=0.01），癌胚抗原（CEA）、糖类抗原199（CA199）和甲胎蛋白（AFP）异常的发生率更高（分别为P=0.01、0.01和0.003），SAT面积（SATA）更小（P=0.009），IAT面积（IATA）更大（P=0.002）。多因素逻辑回归分析表明，N分期（P=0.03）、细胞分级（P=0.01）、AFP（P=0.04）和IATA（P=0.04）是肝转移的独立危险因素。SATA和IATA的联合对肝转移具有良好的预测性能[曲线下面积（AUC）=0.687，95%置信区间（CI）：0.621-0.754]。
术前L3水平的SATA和IATA是接受根治性胃切除的GC患者术后肝转移的重要预测指标。
