Predictive values of multidetector-row computed tomography combined with serum tumor biomarkers in preoperative lymph node metastasis of gastric cancer
|
摘要
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.
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.
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.
引文
1.Li Z, Zhang D, Dai Y, et al. Computed tomographybased radiomics for prediction of neoadjuvant chemotherapy outcomes in locally advanced gastric cancer:A pilot study. Chin J Cancer Res 2018;30:406-14.
2 .Deng J, Liang H, Sun D, et al. Prognosis of gastric cancer patients with node-negative metastasis following curative resection:outcomes of the survival and recurrence. Can J Gastroenterol 2008;22:835-9.
3 .Jeong JY, Kim MG, Ha TK, et al. Prognostic factors on overall survival in lymph node negative gastric cancer patients who underwent curative resection. J Gastric Cancer 2012;12:210-6.
4 .Barros RH, Penachim TJ, Martins DL, et al.Multidetector computed tomography in the preoperative staging of gastric adenocarcinoma.Radiol Bras 2015;48:74-80.
5 .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.
6 .Li F, Li S, Wei L, et al. The correlation between preoperative serum tumor markers and lymph node metastasis in gastric cancer patients undergoing curative treatment. Biomarkers 2013;18:632-7.
7 .Shimada H, Noie T, Ohashi M, et al. Clinical significance of serum tumor markers for gastric cancer:a systematic review of literature by the Task Force of the Japanese Gastric Cancer Association.Gastric Cancer 2014;17:26-33.
8 .Ychou M, Duffour J, Kramar A, et al. Clinical significance and prognostic value of CA72-4compared with CEA and CA19-9 in patients with gastric cancer. Dis Markers 2000;16:105-10.
9 .Jaehne J, Meyer HJ, Maschek H, et al. Lymphadenectomy in gastric carcinoma. A prospective and prognostic study. Arch Surg 1992;127:290-4.
10 .Feng R, Lu S, Sah BK, et al. Serum mi R-126 level combined with multi-detector computed tomography in the preoperative prediction of lymph node metastasis of gastric cancer. Cancer Biomark2018;22:773-80.
11 .Amin MB, Greene FL, Edge SB, et al. The Eighth Edition AJCC Cancer Staging Manual:Continuing to build a bridge from a population-based to a more“personalized” approach to cancer staging. CA Cancer J Clin 2017;67:93-9.
12 .Furukawa K, Miyahara R, Itoh A, et al. Diagnosis of the invasion depth of gastric cancer using MDCT with virtual gastroscopy:comparison with staging with endoscopic ultrasound. AJR Am J Roentgenol2011;197:867-85.
13 .Morgagni P, Petrella E, Basile B, et al. Preoperative multidetector-row computed tomography scan staging for lymphatic gastric cancer spread. World J Surg Oncol 2012;10:197.
14 .Luo M, Lv Y, Guo X, et al. Value and impact factors of multidetector computed tomography in diagnosis of preoperative lymph node metastasis in gastric cancer:A PRISMA-compliant systematic review and meta-analysis. Medicine(Baltimore)2017;96:e7769.
15 .Wang M, Ye Y, Yang Q, et al. Pre-operative lymph node status of gastric cancer evaluated by multidetector computed tomography. Int J Clin Exp Med2015;8:18213-24.
16 .Saito T, Kurokawa Y, Takiguchi S, et al. Accuracy of multidetector-row CT in diagnosing lymph node metastasis in patients with gastric cancer. Eur Radiol2015;25:368-74.
17 .Kim SH, Kim JJ, Lee JS, et al. Preoperative N staging of gastric cancer by stomach protocol computed tomography. J Gastric Cancer 2013;13:149-56.
18 .Almeida MFA, Verza L, Bitencourt AGV, et al.Computed tomography with a stomach protocol and virtual gastroscopy in the staging of gastric cancer:an initial experience. Radiol Bras 2018;51:211-7.
19 .Park SR, Kim MJ, Ryu KW, et al. Prognostic value of preoperative clinical staging assessed by computed tomography in resectable gastric cancer patients:a viewpoint in the era of preoperative treatment. Ann Surg 2010;251:428-35.
20 .Kubota K, Suzuki A, Shiozaki H, et al. Accuracy of multidetector-row computed tomography in the preoperative diagnosis of lymph node metastasis in patients with gastric cancer. Gastrointest Tumors2017;3:163-70.
21 .Yan C, Zhu ZG, Yan M, et al. Value of multidetectorrow computed tomography in the preoperative T and N staging of gastric carcinoma:a large-scale Chinese study. J Surg Oncol 2009;100:205-14.
22 .Kawaguchi T, Komatsu S, Ichikawa D, et al. Nodal counts on MDCT as a surrogate marker for surgical curability in gastric cancer. Ann Surg Oncol 2012;19:2465-70.
23 .Yang AP, Liu J, Lei HY, et al. CA72-4 combined with CEA, CA125 and CAl9-9 improves the sensitivity for the early diagnosis of gastric cancer. Clin Chim Acta2014;437:183-6.
24 .Chen C, Chen Q, Zhao Q, et al. Value of combined detection of serum CEA, CA72-4, CA19-9, CA15-3and CA12-5 in the diagnosis of gastric cancer. Ann Clin Lab Sci 2017;47:260-3.
25 .Kim JH, Jun KH, Jung H, et al. Prognostic value of preoperative serum levels of five tumor markers(carcinoembryonic antigen, CA19-9, alphafetoprotein, CA72-4, and CA125)in gastric cancer.Hepatogastroenterology 2014;61:863-9.
26 .Kim DY, Kim HR, Shim JH, et al. Significance of serum and tissue carcinoembryonic antigen for the prognosis of gastric carcinoma patients. J Surg Oncol2000;74:185-92.
27 .Duraker N, Celik AN. The prognostic significance of preoperative serum CA 19-9 in patients with resectable gastric carcinoma:comparison with CEA. J Surg Oncol 2001;76:266-71.
28 .Ucar E, Semerci E, Ustun H, et al. Prognostic value of preoperative CEA, CA 19-9, CA 72-4, and AFP levels in gastric cancer. Adv Ther 2008;25:1075-84.
29 .Chen XZ, Zhang WK, Yang K, et al. Correlation between serum CA724 and gastric cancer:multiple analyses based on Chinese population. Mol Biol Rep2012;39:9031-9.
30 .Mattar R, Alves de Andrade CR, Di Favero GM, et al.Preoperative serum levels of CA 72-4, CEA, CA 19-9,and alpha-fetoprotein in patients with gastric cancer.Rev Hosp Clin Fac Med Sao Paulo 2002;57:89-92.
31 .Yang XQ, Chen C, Peng CW, et al. Carbohydrate antigen 242 highly consists with carbohydrate antigen 19 -9 in diagnosis and prognosis of colorectal cancer:study on 185 cases. Med Oncol 2012;29:1030-6.
32 .Zhang Y, Yang J, Li H, et al. Tumor markers CA19-9 , CA242 and CEA in the diagnosis of pancreatic cancer:a meta-analysis. Int J Clin Exp Med 2015;8:11683-91.
33 .Seevaratnam R, Cardoso R, Mc Gregor C, et al. How useful is preoperative imaging for tumor, node,metastasis(TNM)staging of gastric cancer? A metaanalysis. Gastric Cancer 2012;15 Suppl 1:S3-18.
2 .Deng J, Liang H, Sun D, et al. Prognosis of gastric cancer patients with node-negative metastasis following curative resection:outcomes of the survival and recurrence. Can J Gastroenterol 2008;22:835-9.
3 .Jeong JY, Kim MG, Ha TK, et al. Prognostic factors on overall survival in lymph node negative gastric cancer patients who underwent curative resection. J Gastric Cancer 2012;12:210-6.
4 .Barros RH, Penachim TJ, Martins DL, et al.Multidetector computed tomography in the preoperative staging of gastric adenocarcinoma.Radiol Bras 2015;48:74-80.
5 .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.
6 .Li F, Li S, Wei L, et al. The correlation between preoperative serum tumor markers and lymph node metastasis in gastric cancer patients undergoing curative treatment. Biomarkers 2013;18:632-7.
7 .Shimada H, Noie T, Ohashi M, et al. Clinical significance of serum tumor markers for gastric cancer:a systematic review of literature by the Task Force of the Japanese Gastric Cancer Association.Gastric Cancer 2014;17:26-33.
8 .Ychou M, Duffour J, Kramar A, et al. Clinical significance and prognostic value of CA72-4compared with CEA and CA19-9 in patients with gastric cancer. Dis Markers 2000;16:105-10.
9 .Jaehne J, Meyer HJ, Maschek H, et al. Lymphadenectomy in gastric carcinoma. A prospective and prognostic study. Arch Surg 1992;127:290-4.
10 .Feng R, Lu S, Sah BK, et al. Serum mi R-126 level combined with multi-detector computed tomography in the preoperative prediction of lymph node metastasis of gastric cancer. Cancer Biomark2018;22:773-80.
11 .Amin MB, Greene FL, Edge SB, et al. The Eighth Edition AJCC Cancer Staging Manual:Continuing to build a bridge from a population-based to a more“personalized” approach to cancer staging. CA Cancer J Clin 2017;67:93-9.
12 .Furukawa K, Miyahara R, Itoh A, et al. Diagnosis of the invasion depth of gastric cancer using MDCT with virtual gastroscopy:comparison with staging with endoscopic ultrasound. AJR Am J Roentgenol2011;197:867-85.
13 .Morgagni P, Petrella E, Basile B, et al. Preoperative multidetector-row computed tomography scan staging for lymphatic gastric cancer spread. World J Surg Oncol 2012;10:197.
14 .Luo M, Lv Y, Guo X, et al. Value and impact factors of multidetector computed tomography in diagnosis of preoperative lymph node metastasis in gastric cancer:A PRISMA-compliant systematic review and meta-analysis. Medicine(Baltimore)2017;96:e7769.
15 .Wang M, Ye Y, Yang Q, et al. Pre-operative lymph node status of gastric cancer evaluated by multidetector computed tomography. Int J Clin Exp Med2015;8:18213-24.
16 .Saito T, Kurokawa Y, Takiguchi S, et al. Accuracy of multidetector-row CT in diagnosing lymph node metastasis in patients with gastric cancer. Eur Radiol2015;25:368-74.
17 .Kim SH, Kim JJ, Lee JS, et al. Preoperative N staging of gastric cancer by stomach protocol computed tomography. J Gastric Cancer 2013;13:149-56.
18 .Almeida MFA, Verza L, Bitencourt AGV, et al.Computed tomography with a stomach protocol and virtual gastroscopy in the staging of gastric cancer:an initial experience. Radiol Bras 2018;51:211-7.
19 .Park SR, Kim MJ, Ryu KW, et al. Prognostic value of preoperative clinical staging assessed by computed tomography in resectable gastric cancer patients:a viewpoint in the era of preoperative treatment. Ann Surg 2010;251:428-35.
20 .Kubota K, Suzuki A, Shiozaki H, et al. Accuracy of multidetector-row computed tomography in the preoperative diagnosis of lymph node metastasis in patients with gastric cancer. Gastrointest Tumors2017;3:163-70.
21 .Yan C, Zhu ZG, Yan M, et al. Value of multidetectorrow computed tomography in the preoperative T and N staging of gastric carcinoma:a large-scale Chinese study. J Surg Oncol 2009;100:205-14.
22 .Kawaguchi T, Komatsu S, Ichikawa D, et al. Nodal counts on MDCT as a surrogate marker for surgical curability in gastric cancer. Ann Surg Oncol 2012;19:2465-70.
23 .Yang AP, Liu J, Lei HY, et al. CA72-4 combined with CEA, CA125 and CAl9-9 improves the sensitivity for the early diagnosis of gastric cancer. Clin Chim Acta2014;437:183-6.
24 .Chen C, Chen Q, Zhao Q, et al. Value of combined detection of serum CEA, CA72-4, CA19-9, CA15-3and CA12-5 in the diagnosis of gastric cancer. Ann Clin Lab Sci 2017;47:260-3.
25 .Kim JH, Jun KH, Jung H, et al. Prognostic value of preoperative serum levels of five tumor markers(carcinoembryonic antigen, CA19-9, alphafetoprotein, CA72-4, and CA125)in gastric cancer.Hepatogastroenterology 2014;61:863-9.
26 .Kim DY, Kim HR, Shim JH, et al. Significance of serum and tissue carcinoembryonic antigen for the prognosis of gastric carcinoma patients. J Surg Oncol2000;74:185-92.
27 .Duraker N, Celik AN. The prognostic significance of preoperative serum CA 19-9 in patients with resectable gastric carcinoma:comparison with CEA. J Surg Oncol 2001;76:266-71.
28 .Ucar E, Semerci E, Ustun H, et al. Prognostic value of preoperative CEA, CA 19-9, CA 72-4, and AFP levels in gastric cancer. Adv Ther 2008;25:1075-84.
29 .Chen XZ, Zhang WK, Yang K, et al. Correlation between serum CA724 and gastric cancer:multiple analyses based on Chinese population. Mol Biol Rep2012;39:9031-9.
30 .Mattar R, Alves de Andrade CR, Di Favero GM, et al.Preoperative serum levels of CA 72-4, CEA, CA 19-9,and alpha-fetoprotein in patients with gastric cancer.Rev Hosp Clin Fac Med Sao Paulo 2002;57:89-92.
31 .Yang XQ, Chen C, Peng CW, et al. Carbohydrate antigen 242 highly consists with carbohydrate antigen 19 -9 in diagnosis and prognosis of colorectal cancer:study on 185 cases. Med Oncol 2012;29:1030-6.
32 .Zhang Y, Yang J, Li H, et al. Tumor markers CA19-9 , CA242 and CEA in the diagnosis of pancreatic cancer:a meta-analysis. Int J Clin Exp Med 2015;8:11683-91.
33 .Seevaratnam R, Cardoso R, Mc Gregor C, et al. How useful is preoperative imaging for tumor, node,metastasis(TNM)staging of gastric cancer? A metaanalysis. Gastric Cancer 2012;15 Suppl 1:S3-18.