Abstract
The objective of this study was to demonstrate computed tomography (CT)-based diagnosis of venous invasion in patients with gastric cancer and its prognostic value. Medical records and CT examinations of 530 patients with gastric cancer diagnosed after biopsy from February 2003 to December 2015 were included in this retrospective study. An imaging-based diagnosis of venous invasion was established when one of the following criteria were satisfied: 1) tumoral enhancement in the lumen of the vein, 2) tumor protruding through the course of a vein, and 3) distention of the vein due to extension of the gastric tumor. CT-based diagnosis of gastric vein invasion was established in 11/530 patients. Histopathological examination revealed poorly differentiated gastric adenocarcinoma (n=10) and neuroendocrine carcinoma (n=1). The median survival of the patients after the initial CT was 153.5 (range: 6-1275) days. Tumor invasion was observed at the aberrant left gastric vein (n=2), right gastroepiploic and superior mesenteric vein (n=2), gastric vein (n=4), and short gastric vein (n=3). Two of the three patients with short gastric vein invasion died 6 and 7 days after the initial CT, respectively. All draining veins of the stomach can be invaded by gastric cancer; CT can enable diagnosis that may be important for prognosis and surgical planning. The presence of short gastric vein invasion detected by CT may be associated with poor prognosis.
Highlights
Gastric cancer is still the cause for a considerable amount of cancer-related deaths worldwide [1,2,3]
All draining veins of the stomach can be invaded by gastric cancer; computed tomography (CT) can enable diagnosis that may be important for prognosis and surgical planning
The presence of short gastric vein invasion detected by CT may be associated with poor prognosis
Summary
Gastric cancer is still the cause for a considerable amount of cancer-related deaths worldwide [1,2,3]. In a study by Nakanishi et al [11], histological differentiation, depth of tumor invasion, presence of metastases, and venous invasion were found to be main prognostic factors of overall survival in patients with gastric carcinoma. The usual late presentation of the disease is responsible for the poor survival rate, the presence of venous invasion is further reported to be a reliable independent prognostic factor in early-stage gastric cancer [12, 13]. Araki et al [13] concluded that moderate or marked venous invasion was an independent predictor of relapse-free and overall survival in patients with stage IB node-negative gastric cancer. Several molecular markers have been found to be useful in predicting poor prognostic factors related with venous invasion in gastric cancer [14,15,16].
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