Abstract
PurposeTo determine whether gross tumor volume of resectable gastric adenocarcinoma on multidetector computed tomography could predict presence of lymphovascular invasion and T-stages.ResultsGross tumor volume increased with the lymphovascular invasion (r = 0.426, P < 0.0001) and T stage (r = 0.656, P < 0.0001). Univariate analysis showed gross tumor volume could predict lymphovascular invasion (P < 0.0001). Multivariate analyses indicated gross tumor volume as an independent risk factor of lymphovascular invasion (P = 0.026, odds ratio = 2.284). The Mann-Whitney U test showed gross tumor volume could distinguish T2 from T3, T1 from T2–T4a, T1–T2 from T3–T4a and T1–T3 from T4a (P = 0.000). In the development cohort, gross tumor volume could predict lymphovascular invasion (cutoff, 15.92 cm3; AUC, 0.760), and distinguish T2 from T3 (cutoff, 10.09 cm3; AUC, 0.828), T1 from T2-T4a (cutoff, 8.20 cm3; AUC, 0.860), T1-T2 from T3-T4a (cutoff, 15.88 cm3; AUC, 0.883), and T1-T3 from T4a (cutoff, 21.53 cm3; AUC, 0.834). In validation cohort, gross tumor volume could predict presence of lymphovascular invasion (AUC, 0.742), and distinguish T2 from T3 (AUC, 0.861), T1 from T2-T4a (AUC, 0.859), T1–T2 from T3–T4a (AUC, 0.875), and T1–T3 from T4a (AUC, 0.773).Materials and Methods360 consecutive patients with gastric adenocarcinoma were retrospectively identified. Gross tumor volume was evaluated on multidetector computed tomography images. Statistical analysis was performed to determine whether gross tumor volume could predict presence of lymphovascular invasion and T-stages. Cutoffs of gross tumor volume were first investigated in 212 patients and then validated in an independent 148 patients using area under the receiver operating characteristic curve (AUC) for predicting lymphovascular invasion and T-stages.ConclusionsGross tumor volume of resectable gastric adenocarcinoma at multidetector computed tomography demonstrated capability in predicting lymphovascular invasion and distinguishing T-stages.
Highlights
Despite its decreasing incidence in western countries and china, gastric adenocarcinoma is the fifth most common cancers and the third most common cause of cancer-related mortality worldwide [1, 2]
Patients with early stage gastric adenocarcinoma has been reported to be rarely accompanied by lymph node invasion, and these patients can receive the less-invasive endoscopic procedure such as endoscopic mucosal resection [6, 7]; For advanced gastric adenocarcinoma, neoadjuvant chemotherapy is an emerging option for marginally resectable gastric cancers as it may lead to downsizing or downstaging of the tumor, facilitating its complete resection and improving the patient prognosis [8]
The coefficient of variation (CV) was less than 10% and interobserver variability of gross tumor volume (GTV) was small, and average values of both measurements were regarded as the final GTV
Summary
Despite its decreasing incidence in western countries and china, gastric adenocarcinoma is the fifth most common cancers and the third most common cause of cancer-related mortality worldwide [1, 2]. Lymphovascular invasion (LVI) was an independent factor for lymph node metastasis (LNM) and the prognosis of resectable gastric cancer patients [9,10,11]. The combination of traditional TNM staging with an assessment for LVI could lead to a more accurate indication of the patient’s prognosis [11]. In addition to TNM staging, LVI has been proved a prognostic indicator that will aid in the identification of gastric caner patients with a higher risk for the recurrence including peritoneal seeding, and these patients should be candidates for more extensive adjuvant chemotherapy to reduce recurrence rates [3, 12]. Accurate assessment of LVI was important in predicting prognosis and determining the most appropriate treatment planning
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