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CT findings in diagnosis of gastric bare area invasion: potential prognostic factors for proximal gastric carcinoma

  • Rui-Jia Sun
  • Lei Tang
  • Xiao-Ting Li
  • Zi-Yu Li
  • Ying-Shi SunEmail author
Original Article
  • 39 Downloads

Abstract

Purpose

To investigate the correlation between the preoperative CT findings in diagnosis of gastric bare area (GBA) invasion and the 3-year-overall survival (OS) of patients with proximal gastric carcinoma (PGC).

Methods

108 consecutive patients with PGC confirmed by biopsy underwent MDCT scan prior to gastrectomy were enrolled retrospectively from Dec 2009 to Dec 2014. GBA invasion in PGC were evaluated by measuring the direct CT signs including transmural involvement and lymph nodes in the GBA. The indirect signs were also evaluated including the infiltration of the diaphragm, gastrophrenic ligament and perigastric fat. Kaplan–Meier estimates with log-rank test and Cox proportional hazard model were used for analysis.

Results

The two raters achieved excellent agreement. Univariate Kaplan–Meier estimates indicated that postoperative chemotherapy (p = 0.003), transmural involvement (p < 0.001), lymph nodes in the GBA (p = 0.015) and cT staging (p = 0.002) were associated with OS. Cox proportional hazard model indicated that the transmural involvement (HR = 8.194, 95% CI 2.15–31.266), diaphragm involvement (HR = 0.21, 95% CI 0.042–0.986), perigastric fat infiltration (HR = 0.125, 95% CI 0.018–0.885; HR = 0.02, 95% CI 0.001–0.264), and cT staging were independent prognostic factors for OS.

Conclusion

CT findings of GBA invasion in patients with PGC, not only the transmural involvement but also the indirect signs are independent prognostic factors potentially, which should be given more emphasis in future clinical practice.

Keywords

Gastric cancer Anatomy CT Prognosis 

Abbreviations

PGC

Proximal gastric carcinoma

GBA

Gastric bare area

MDCT

Multidetector computed tomography

cT

Clinical T stage

pT

Pathological T stages

LN

Lymph nodes

Notes

Acknowledgements

This study was supported by Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding Support (no. ZYLX201803) and Beijing Natural Science Foundation (7172049).

Author contributions

Y-SS is acting as the guarantor of the article, and was responsible for the study design and for preparation of the manuscript. R-JS and LT were responsible for the study design and data collection. X-TL and Z-YL were responsible for development of methodology. All co-authors had input into study design, conduct, data analysis or interpretation. All co-authors critically reviewed the manuscript, and necessary revisions were made to accommodate their suggestions and opinions.

Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest to declare.

Ethical statement

This retrospective study was approved by the institutional review board of our institute, and the requirement of informed consent was waived.

References

  1. 1.
    Choi JK, Park YS, Jung DH, et al. Clinical relevance of the tumor location-modified lauren classification system of gastric cancer. J Gastric Cancer. 2015;15:183–90.CrossRefGoogle Scholar
  2. 2.
    Cordin J, Lehmann K, Schneider PM. Clinical staging of adenocarcinoma of the esophagogastric junction. Recent Results Cancer Res. 2010;182:73–83.CrossRefGoogle Scholar
  3. 3.
    Kawanami S, Komori M, Tsurumaru D, Matsuura S, Nishie A, Honda H. Description of early gastric cancer with wall-carving technique on multidetector computed tomography. Jpn J Radiol. 2011;29(1):76–82.CrossRefGoogle Scholar
  4. 4.
    Tsurumaru D, Miyasaka M, Muraki T, Asayama Y, Nishie A, Oki E, et al. Diffuse-type gastric cancer: specific enhancement pattern on multiphasic contrast-enhanced computed tomography. Jpn J Radiol. 2017;35(6):289–95.CrossRefGoogle Scholar
  5. 5.
    Lee JH, Park MS, Kim KW, Yu JS, Kim MJ, Yang SW, et al. Advanced gastric carcinoma with signet ring cell carcinoma versus non-signet ring cell carcinoma: differentiation with multidetector CT. J Comput Assist Tomogr. 2006;30(6):880–4.CrossRefGoogle Scholar
  6. 6.
    Matsui H, Anno H, Uyama I, Sugioka A, Ochiai M, Katada K, et al. Relatively small size linitis plastica of the stomach: multislice CT detection of tissue fibrosis. Abdom Imaging. 2007;32(6):694–7.CrossRefGoogle Scholar
  7. 7.
    Bruno L, Nesi G, Montinaro F, et al. Clinicopathologic findings and results of surgical treatment in cardiac adenocarcinoma. J Surg Oncol. 2000;74:33–5.CrossRefGoogle Scholar
  8. 8.
    Tonelli P, Gastric carcinomas of the ‘‘bare area’’. Their anatomo-surgical definition and proposal of an en bloc total gastrectomy. Ann Ital Chir 1999; 70: 405-19.Google Scholar
  9. 9.
    Siewert JR, Bottcher K, Stein HJ, et al. Problem of proximal third gastric carcinoma. World J Surg. 1995;19:523–31.CrossRefGoogle Scholar
  10. 10.
    Bing Wu, Min Peng-qiu, Yang Kaiqing. Utility of multidetector CT in the diagnosis of gastric bare area invasion by proximal gastric carcinoma. Abdom Imaging. 2007;32:284–9.CrossRefGoogle Scholar
  11. 11.
    Salvon-Harman JC, Cady B, Nikulasson S, et al. Shifting proportions of gastric adenocarcinomas. Arch Surg. 1994;129:381–9.CrossRefGoogle Scholar
  12. 12.
    Habermann CR, Weiss F, Riecken R, et al. Preoperative staging of gastric adenocarcinoma: comparison of helical CT and endoscopic US. Radiology. 2004;230:465–71.CrossRefGoogle Scholar
  13. 13.
    Lee DH, Seo TS, Ko YT. Spiral CT of the gastric carcinoma: staging and enhancement pattern. Clin Imaging. 2001;25:32–7.CrossRefGoogle Scholar
  14. 14.
    Min PQ, Yang ZG, Lei QF, et al. Peritoneal reflections of left perihepatic region: radiologic-anatomic study. Radiology. 1992;182:553–7.CrossRefGoogle Scholar
  15. 15.
    Zhao Z, Liu S, Li Z, et al. Sectional anatomy of the peritoneal reflections of the upper abdomen in the coronal plane. J Comput Assist Tomogr. 2005;29:430–7.CrossRefGoogle Scholar
  16. 16.
    Ma G, Liu SW, Zhao ZM, et al. Sectional anatomy of the adrenal gland in the coronal plane. Surg Radiol Anat. 2008;30:271–80.CrossRefGoogle Scholar
  17. 17.
    Chae S, Lee A, Lee JH. The effectiveness of the new (7th) UICCN classification in the prognosis evaluation of gastric cancer patients: a comparative study between the 5th/6th and 7th UICC N classification. Gastric Cancer. 2011;14:166–71.CrossRefGoogle Scholar
  18. 18.
    Deng J, Liang H, Sun D, et al. Suitability of 7th UICC N stage for predicting the overall survival of gastric cancer patients after curative resection in China. Ann Surg Oncol. 2010;17:1259–66.CrossRefGoogle Scholar

Copyright information

© Japan Radiological Society 2019

Authors and Affiliations

  1. 1.From Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of RadiologyPeking University Cancer Hospital and InstituteBeijingChina
  2. 2.From Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of SurgeryPeking University Cancer Hospital and InstituteBeijingChina

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