Wu Bo, Tian Wen-Jie, Li Lin, Zhu Yuan-Qing, Sun Ying-Gang
Department of Gastrointestinal Surgery, The 960th Hospital of the PLA Joint Logistics Support Force, Jinan, Shandong, 250000, People's Republic of China.
Department of Clinical Laboratory, Shanghai East Hospital South Campus, Tongji University School of Medicine, Shanghai, 200123, People's Republic of China.
Int J Gen Med. 2025 Sep 17;18:5581-5589. doi: 10.2147/IJGM.S513034. eCollection 2025.
To investigate the predictive value of preoperative [F]fluorodeoxyglucose ([F]FDG) positron emission tomography/computed tomography (PET/CT)-derived heterogeneity index (HI) for occult lymph node metastasis (OLM) in clinical N0 gastric adenocarcinoma.
This retrospective study included 83 patients with clinical N0 gastric adenocarcinoma who underwent [F]FDG PET/CT scans before radical surgery between March 2018 and June 2024. Patients were classified as OLM-positive (n=40) or OLM-negative (n=43) based on postoperative pathology. Clinical characteristics, PET/CT metabolic parameters [maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean), peak standardized uptake value (SUVpeak), tumor-to-liver ratio (TLR), metabolic tumor volume (MTV), and total lesion glycolysis (TLG)], and heterogeneity indices (HI-1 and HI-2) were analyzed. Univariate and multivariate logistic regression models were applied to identify independent predictors of OLM. ROC curve analysis was performed to assess diagnostic performance. Statistical analysis was conducted using SPSS version 26.0, with P<0.05 considered statistically significant.
Gender, tumor differentiation, and pathological T stage differed significantly between the two groups (P<0.05). HI-2 was significantly higher, while SUVmax, SUVmean, and HI-1 were significantly lower in the OLM-positive group (P<0.05). Multivariate analysis identified pathological T stage (T3-T4, OR=4.778, P=0.022) and HI-2 >4.959 (OR=6.887, P=0.002) as independent predictors of OLM. ROC analysis revealed that HI-2 had an AUC of 0.711 (95% CI: 0.596-0.824, P=0.001), with 52.5% sensitivity and 88.37% specificity at the optimal threshold.
HI-2 derived from preoperative [F]FDG PET/CT is a significant independent predictor of OLM in clinical N0 gastric adenocarcinoma patients, alongside pathological T stage.
探讨术前[F]氟脱氧葡萄糖（[F]FDG）正电子发射断层扫描/计算机断层扫描（PET/CT）得出的异质性指数（HI）对临床N0期胃腺癌隐匿性淋巴结转移（OLM）的预测价值。
这项回顾性研究纳入了83例在2018年3月至2024年6月期间接受根治性手术前进行[F]FDG PET/CT扫描的临床N0期胃腺癌患者。根据术后病理将患者分为OLM阳性组（n = 40）和OLM阴性组（n = 43）。分析临床特征、PET/CT代谢参数[最大标准化摄取值（SUVmax）、平均标准化摄取值（SUVmean）、峰值标准化摄取值（SUVpeak）、肿瘤与肝脏比值（TLR）、代谢肿瘤体积（MTV）和总病变糖酵解（TLG）]以及异质性指数（HI-1和HI-2）。应用单因素和多因素逻辑回归模型确定OLM的独立预测因素。进行ROC曲线分析以评估诊断性能。使用SPSS 26.0版本进行统计分析，P<0.05被认为具有统计学意义。
两组之间的性别、肿瘤分化程度和病理T分期存在显著差异（P<0.05）。OLM阳性组的HI-2显著更高，而SUVmax、SUVmean和HI-1显著更低（P<0.05）。多因素分析确定病理T分期（T3-T4，OR = 4.778，P = 0.022）和HI-2>4.959（OR = 6.887，P = 0.002）为OLM的独立预测因素。ROC分析显示，HI-2的AUC为0.711（95%CI：0.596-0.824，P = 0.001），在最佳阈值时敏感性为52.5%，特异性为88.37%。
术前[F]FDG PET/CT得出的HI-2是临床N0期胃腺癌患者OLM的重要独立预测因素，与病理T分期一样。
