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Diagnostic accuracy of dual-energy CT-based nomograms to predict lymph node metastasis in gastric cancer

  • Gastrointestinal
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To develop and validate a dual-energy CT based nomogram for the preoperative prediction of lymph node metastasis (LNM) in patients with gastric cancer (GC).

Methods

A total of 210 surgically confirmed GC patients (159 males, 51 females; mean age: 59.8 ± 7.7 years, range: 28-79 years) who underwent spectral CT scans were retrospectively enrolled and split into a primary cohort (n = 140) and validation cohort (n = 70). Clinical information and follow-up data including overall survival (OS) and progression-free survival (PFS) were collected. The iodine concentration (IC) of the primary tumors at the arterial phase (AP) and venous phase (VP) were measured and then normalized to the aorta (nICs). Univariate, multivariable logistic regression and Cox regression analyses were performed to screen predictive indicators for LNM and outcome. A nomogram for risk factors of LNM was developed, and its performance was measured using the ROC, accuracy and Harrell’s concordance index (C-index).

Results

Tumor thickness, Borrmann classification and ICVP were independent predictors of LNM. The nomogram was significantly associated with LN status (p < 0.001). It yielded an AUC of 0.793 [95% confidence interval (95% CI), 0.678-0.908] and an accuracy of 0.757 (95% CI, 0.640-0.852) in the internal-validation cohort. The nomogram also exhibited a prognostic ability with C-indices of 0.675 (95% CI, 0.571-0.779; p < 0.001) for PFS and 0.643 (95% CI, 0.518-0.768; p = 0.025) for OS.

Conclusion

This study presented a dual-energy quantification-based nomogram, which can be used to facilitate the preoperative individualized prediction of LNM in patients with GC.

Key Points

• This study first developed and internally validated a dual-energy CT-based nomogram to predict lymph node metastasis in patients with gastric cancer.

• The nomogram incorporated the clinical risk factors and iodine concentration, which would enable superior preoperative individual prediction of lymph node metastasis and add more information for the optimal therapeutic strategy.

• The nomogram also exhibited a significant prognostic ability for progression-free and overall survival.

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Abbreviations

AP:

Arterial phase

AUC:

Area under the curve

EUS:

Endoscopic ultrasonography

GC:

Gastric cancer

GSI:

Gem spectral imaging

IC:

Iodine concentration

LNM:

Lymph node metastasis

MRI:

Magnetic resonance imaging

MVD:

Microvessel density

NCCN:

National Comprehensive Cancer Network

PET/CT:

Positron emission tomography/computed tomography

PNR:

Positive node ratio

ROI:

Region of interest

T:

Tumor

VEGF:

Vascular endothelial growth factor

VP:

Venous phase

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Funding

This study has received funding by National Natural and Science Fund of China (no. 81271573).

Author information

Author notes

  1. Jing Li and Mengjie Fang contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1, East Jianshe Road, Zhengzhou, 450052, Henan, China

    Jing Li, Rui Wang, Pan Liang, Jie Liu & Jianbo Gao

  2. Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University (Henan Cancer Hospital), Zhengzhou, 450008, Henan, China

    Jing Li

  3. CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China

    Mengjie Fang, Di Dong & Jie Tian

  4. University of Chinese Academy of Sciences, Beijing, 100190, China

    Mengjie Fang, Di Dong & Jie Tian

Authors
  1. Jing Li
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Corresponding author

Correspondence to Jianbo Gao.

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Guarantor

The scientific guarantor of this publication is Jianbo Gao.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board of Zhengzhou University.

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Institutional Review Board approval was obtained.

Methodology

• retrospective

• diagnostic or prognostic study

• performed at one institution

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Li, J., Fang, M., Wang, R. et al. Diagnostic accuracy of dual-energy CT-based nomograms to predict lymph node metastasis in gastric cancer. Eur Radiol 28, 5241–5249 (2018). https://doi.org/10.1007/s00330-018-5483-2

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  • DOI: https://doi.org/10.1007/s00330-018-5483-2

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