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Impact of Combination Criteria of Nodal Counts and Sizes on Preoperative MDCT in Advanced Gastric Cancer

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Abstract

Background

This study was designed to establish a new diagnostic criteria of preoperative nodal status with high specificity on multidetector row computed tomography (MDCT) to extract advanced gastric cancer (GC) patients with an unfavorable prognosis.

Method

From total of 480 GC patients who underwent surgical resection, 58 consecutive patients with a preoperative diagnosis of nodal metastasis on MDCT were included in this retrospective study. Nodal status on MDCT was reassessed and a prognostic analysis was performed in the present study.

Results

Among several clinical nodal diagnostic criteria on MDCT, a cut-off value of the short-axis diameter measuring ≥15 mm showed the highest specificity (100 %). The prognostic analysis revealed that patients with nodal counts on MDCT of ≥3 (p = 0.035) as well as those with a nodal diameter ≥15 mm (p < 0.001) had a significantly poor prognosis. When patients with nodal counts ≥3 and at least one node that was ≥15 mm in diameter on MDCT were defined as having extensive lymph node metastasis (ELM) that had a significantly poor prognosis (5-year survival rates of 20 %, p < 0.001), and ELM was also an independent poor prognostic factor in advanced GC (p = 0.033, hazard ratio 4.038).

Conclusion

GC patients with nodal counts ≥3 and at least one node that was ≥15 mm in diameter on MDCT have extremely worse prognose with high diagnostic specificity. This novel surrogate indicator for preoperative imaging diagnosis may help personalized therapeutic strategies for GC patients with ELM.

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Authors and Affiliations

  1. Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 6028566, Japan

    Tsutomu Kawaguchi, Daisuke Ichikawa, Shuhei Komatsu, Toshiyuki Kosuga, Takeshi Kubota, Kazuma Okamoto, Atsushi Shiozaki, Hitoshi Fujiwara, Hirotaka Konishi, Ryo Morimura, Yasutoshi Murayama, Yoshiaki Kuriu, Hisashi Ikoma, Masayoshi Nakanishi, Chouhei Sakakura & Eigo Otsuji

Authors
  1. Tsutomu Kawaguchi
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  2. Daisuke Ichikawa
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  3. Shuhei Komatsu
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  4. Toshiyuki Kosuga
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  5. Takeshi Kubota
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  6. Kazuma Okamoto
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  7. Atsushi Shiozaki
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  11. Yasutoshi Murayama
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  12. Yoshiaki Kuriu
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  13. Hisashi Ikoma
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  14. Masayoshi Nakanishi
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  15. Chouhei Sakakura
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  16. Eigo Otsuji
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Corresponding author

Correspondence to Daisuke Ichikawa.

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Kawaguchi, T., Ichikawa, D., Komatsu, S. et al. Impact of Combination Criteria of Nodal Counts and Sizes on Preoperative MDCT in Advanced Gastric Cancer. World J Surg 40, 158–164 (2016). https://doi.org/10.1007/s00268-015-3007-7

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  • DOI: https://doi.org/10.1007/s00268-015-3007-7

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