Abstract
OBJECTIVE:To determine whether the gross tumor volume of resectable gastric adenocarcinoma on multidetector computed tomography could predict the presence of regional lymph node metastasis and could determine N categories.MATERIALS AND METHODS:A total of 202 consecutive patients with gastric adenocarcinoma who had undergone gastrectomy 1 week after contrast-enhanced multidetector computed tomography were retrospectively identified. The gross tumor volume was evaluated on multidetector computed tomography images. Univariate and multivariate analyses were performed to determine whether the gross tumor volume could predict regional lymph node metastasis, and the Mann-Whitney U test was performed to compare the gross tumor volume among N categories. Additionally, a receiver operating characteristic analysis was performed to identify the accuracy of the gross tumor volume in differentiating N categories.RESULTS:The gross tumor volume could predict regional lymph node metastasis (p<0.0001) in the univariate analysis, and the multivariate analyses indicated that the gross tumor volume was an independent risk factor for regional lymph node metastasis (p=0.005, odds ratio=1.364). The Mann-Whitney U test showed that the gross tumor volume could distinguish N0 from the N1-N3 categories, N0-N1 from N2-N3, and N0-N2 from N3 (all p<0.0001). In the T1-T4a categories, the gross tumor volume could differentiate N0 from the N1-N3 categories (cutoff, 12.3 cm3), N0-N1 from N2-N3 (cutoff, 16.6 cm3), and N0-N2 from N3 (cutoff, 24.6 cm3). In the T4a category, the gross tumor volume could differentiate N0 from the N1-N3 categories (cutoff, 15.8 cm3), N0-N1 from N2-N3 (cutoff, 17.8 cm3), and N0-N2 from N3 (cutoff, 24 cm3).CONCLUSION:The gross tumor volume of resectable gastric adenocarcinoma on multidetector computed tomography could predict regional lymph node metastasis and N categories.
Highlights
Gastric cancer is one of the most common cancers and the second most common cause of cancer-related mortality worldwide, and most gastric cancers are gastric adenocarcinoma [1,2]
Extended lymphadenectomy cannot be recommended for the treatment of all patients with gastric cancer, and accurate noninvasive assessment of Lymph node metastasis (LNM) and the N category plays an important role in determining whether these patients should undergo complete resection of the primary tumor and more extensive lymphadenectomies
receiver-operating characteristic (ROC) analyses of accuracy of gross tumor volume (GTV) of gastric adenocarcinoma in differentiating N categories Using ROC analysis of the T1-T4a categories, we found that the GTV could help to differentiate N0 from the N1-N3 categories, N0-N1 from the N2-N3, and N0-N2 from N3 (Figure 2)
Summary
Gastric cancer is one of the most common cancers and the second most common cause of cancer-related mortality worldwide, and most gastric cancers are gastric adenocarcinoma [1,2]. According to the 7th edition of the American Joint Committee on Cancer (AJCC) staging system, released in 2010, at least 16 regional lymph nodes should be assessed pathologically to determine the N category [6]. An increasing incidence of LNM has been observed in patients who undergo extended lymphadenectomy, postoperative morbidity and mortality remain high [7,8,9]. Extended lymphadenectomy cannot be recommended for the treatment of all patients with gastric cancer, and accurate noninvasive assessment of LNM and the N category plays an important role in determining whether these patients should undergo complete resection of the primary tumor and more extensive lymphadenectomies
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