CT volumetry for gastric adenocarcinoma: association with lymphovascular invasion and T-stages

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.

Differentiating T1a-T1b from T2 in Gastric Cancer Lesions with Three Different Measurement Approaches Based on Contrast-enhanced T1W Imaging at 3.0 Tesla

“…Two previous studies (18)(19) evaluated the CT volumetry correlation with T stage in GC and demonstrated that CT volumetry was capable of distinguishing T1 stage from higher T stages in GC, which was consistent with our ndings. The accuracies of differentiating T1 stage from higher T stages of the two previous studies were 95% and 80.7%, respectively (18)(19).…”

“…Two previous studies (18)(19) evaluated the CT volumetry correlation with T stage in GC and demonstrated that CT volumetry was capable of distinguishing T1 stage from higher T stages in GC, which was consistent with our ndings. The accuracies of differentiating T1 stage from higher T stages of the two previous studies were 95% and 80.7%, respectively (18)(19). The optimal cut off values of CT volumetry for differentiating T1 from higher stages derived from the two studies were 19.4 and 8.2 cm 3 (18)(19), respectively, which were both distinctly higher than the cutoff value noted in the present study (1.34cm 3 ).…”

“…Other studies evaluated the diagnostic value of CT volumetry in T staging of GC tumors and demonstrated the ability of predicting the T1 stage, with a sample size of 19 and 13 patients, respectively and with an accuracy of 80.7% and 95% in differentiating T1 stage from other higher stages, respectively (18)(19). Furthermore, the thickness of GC in untreated patients was relatively stable which is not affected by the degree of gastric lling (5).…”

Prognostic value of calculated tumor volume (cTV) in T4 or N3 advanced gastric cancer

“…In numerous previous studies, investigators tried to estimate tumor volume with imaging tools, such as computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET)computed tomography (CT), and their results sought that it was contributing to poor prognosis of patients [20][21][22][23]. However, in these studies, errors with the actual tumor range, including the inability to measure in image studies according to tumor shape and pattern, cannot be overlooked.…”

“…Meanwhile, for advanced gastric cancer, the interactions between tumors burden and lymphovascular invasion would likely increase with increasing tumor volume. Therefore, as tumor volume increase, so would the probability of micrometastases migrating from the tumor through the lymphatic vessels, increasing the postoperative recurrence rate and resulting in poorer prognosis [20,24,25]. Moreover, for tumors that invade the serosa, thus penetrating the gastric wall, tumor size is likely associated with a larger area of serosal invasion, increasing the likelihood of intraperitoneal dissemination and poorer prognosis.…”