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.
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.
Authors: Paolo Morgagni; Enrico Petrella; Barbara Basile; Alberto Mami; Augusto Soro; Andrea Gardini; Filippo Calzolari; Domenico Garcea; Mauro Bertocco Journal: World J Surg Oncol Date: 2012-09-24 Impact factor: 2.754