Predictive values of multidetector-row computed tomography combined with serum tumor biomarkers in preoperative lymph node metastasis of gastric cancer

Abstract

Objective Multidetector-row computed tomography (MDCT) and serum tumor biomarkers are commonly used to evaluate the preoperative lymph node metastasis and the clinical staging of gastric cancer (GC). This study intends to evaluate the clinical predictive value of MDCT and serum tumor biomarkers in lymph node metastasis of GC. Methods The clinicopathologic data of 445 GC patients who underwent radical gastrectomy were retrospectively analyzed to evaluate the diagnostic value of MDCT and serum tumor biomarkers in lymph node metastatic staging of GC before surgery. Results With the multinomial logistic regression analysis, the independent relative factors of lymph node metastasis of GC were identified as tumor size, depth of tumor invasion, vessel invasion, vascular embolus, and soft tissue invasion. The optimal critical value of the short diameter of lymph nodes detected by MDCT scanning for evaluation of preoperative lymph node metastasis was 6.0 mm, with 75.7% as predictive accuracy of lymph node metastasis compared to the postoperative pathological results of GC patients. In addition, the critical value of the short diameter of lymph nodes combined with serum tumor biomarkers [including carbohydrate antigen (CA)-724 and CA-199] could show an enhancement of predictive sensitivity of lymph node metastasis (up to 89.3%) before surgery. Conclusions MDCT combined with serum tumor biomarkers should be adopted to improve preoperative sensitivity and accuracy of lymph node metastasis for GC patients.

The value of multidetector-row computed tomography in lymph node staging of gastric cancer: a preliminary Vietnamese study

“…In the present study, using size as an independent standard, the AUROC value was 0.738, with an optimal cutoff point of 7.5 mm, resulting in a sensitivity and specificity of 71.5% and 70.5%, respectively. These results were similar to those reported by Yan et al [14] (AUROC: 0.789, cut-off value: 0.585 cm, sensitivity: 80.2%, and specificity: 66.4%) and Bai et al [20] (AUROC: 0.807, cut-off point: 6.0 mm, sensitivity: 75.8%, and specificity: 75.6%).…”

“…The criteria for defining metastatic lymph nodes using preoperative MDCT differed among previous studies. Most studies defined metastatic lymph nodes based on the short-axis diameter, with nodes considered to be metastatic if the short-axis diameter was larger than 10 mm [20], 8 mm [6,21,22], or 6 mm for perigastric lymph nodes, and larger than 8 mm for extraperigastric lymph nodes [14,23]. In addition to size, central necrosis, strong enhancement, and clusters of three or more perilesional nodes were also considered to be indicators of local metastasis.…”

“…[ 14 ] (AUROC: 0.789, cut-off value: 0.585 cm, sensitivity: 80.2%, and specificity: 66.4%) and Bai et al . [ 20 ] (AUROC: 0.807, cut-off point: 6.0 mm, sensitivity: 75.8%, and specificity: 75.6%).…”

Distinguish the Role of Radiotherapy From Chemoradiotherapy for Gastric Cancer With Behavior of Metastasis-Indolent in Lymph Node

“…Besides, MILN is a relevant concept, and the pathology result of LN-negative may not guarantee MILN nature and the number of LNs examined after gastrectomy might affect the detection of LN-metastasis status. 37 - 40 Thus, to compensate for this limitation, in our study, only patients with more than 15 LN examined were enrolled since this feature was defined as a surrogate for the evaluation of LN dissection. 41 , 42 …”

Current status and future perspectives on neoadjuvant therapy in gastric cancer

“…( 38 - 40 ). Multidetector-row CT combined with serum tumor biomarkers can be adopted to improve preoperative sensitivity (up to 89.3%) of lymph node metastasis for GC patients ( 41 ). Interestingly, a CT-based radiomics nomogram for predicting HER2 status is built and validated in patients with GC so as to guide clinical treatment ( 42 ).…”