Objective To assess the feasibility of scoring extragastric vascular invasion and occult peritoneal metastasis using preoperative computed tomography (CT) images of gastric cancer (GC) and to explore the correlation between these scores and patient prognosis. Methods 587 GC patients with CT scans from two centers, all confirmed by pathology, were retrospectively evaluated. Scores for CT-detected blood vessel invasion (ctBVI), lymphatic invasion (ctLVI), and occult peritoneal metastasis (ctOPM) were assigned based on preoperative CT images. The patients’ follow-up provided data on overall and disease-free survival. Cox proportional hazard models were used to analyze prognostic factors. Results The inter-group and intra-group consistency of ctBVL, ctLVI, and ctOPM scores were all > 0.70. Log-rank analysis demonstrated a statistically significant difference in survival curves (p < 0.001). CtBVL, ctLVI, and ctOPM scores were related to overall survival (OS) and disease-free survival (DFS). Univariate and multivariate Cox regression analyses identified ctBVL, ctLVI, ctOPM scores as independent risk factors for GC prognosis. In multivariate analysis, the three sign scores were related to DFS (p < 0.05), with ctBVL (hazard ratio (HR) = 1.980, 95% CI: 1.336–2.933), ctLVI (HR = 1.502, 95% CI: 1.336–2.933), and ctOPM (HR = 1.182, 95% CI: 0.886–1.578). The three scores were also correlated with OS (p < 0.05), ctBVL (HR = 2.003, 95% CI: 1.278–3.139), ctLVI (HR = 1.523, 95% CI:1.055–2.200) and ctOPM (HR = 1.289, 95% CI: 1.013–1.770). Conclusion CtBVL, ctLVI, and ctOPM scores are valuable prognostic indicators in gastric cancer, influencing both OS and DFS. Key Points <Emphasis Type="BoldItalic">Question</Emphasis> To study whether the ctBVL, ctLVI, and ctOPM scores assessed by preoperative enhanced CT imaging can predict the survival outcomes of patients. <Emphasis Type="BoldItalic">Findings</Emphasis> CtBVL, ctLVI, and ctOPM scores, assessed via preoperative enhanced CT imaging, are associated with worse survival outcomes when elevated. <Emphasis Type="BoldItalic">Clinical relevance</Emphasis> CtBVL, ctLVI, and ctOPM scores may help guide personalized follow-up plans. Patients with higher scores might require closer monitoring and more aggressive treatment. Graphical Abstract

CT-based scores for extramural vascular invasion and occult peritoneal metastasis correlate with gastric cancer survival

期刊论文
发表日期：

2025年3月18日

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Qingwan Li,
Zhaojuan Jiang,
Yun Zhu,
Siwei Lu,
Jinqiu Ruan,
Yanli Li,
Keyu Mao,
Jing Ai,
Yongzhou Xu,
YuTing Liao,
Guangjun Yang,
Yu Xie,
Depei Gao,
Yanni Huang,
Zhenhui Li

摘要

Objective

To assess the feasibility of scoring extragastric vascular invasion and occult peritoneal metastasis using preoperative computed tomography (CT) images of gastric cancer (GC) and to explore the correlation between these scores and patient prognosis.

Methods

587 GC patients with CT scans from two centers, all confirmed by pathology, were retrospectively evaluated. Scores for CT-detected blood vessel invasion (ctBVI), lymphatic invasion (ctLVI), and occult peritoneal metastasis (ctOPM) were assigned based on preoperative CT images. The patients’ follow-up provided data on overall and disease-free survival. Cox proportional hazard models were used to analyze prognostic factors.

Results

The inter-group and intra-group consistency of ctBVL, ctLVI, and ctOPM scores were all > 0.70. Log-rank analysis demonstrated a statistically significant difference in survival curves (p < 0.001). CtBVL, ctLVI, and ctOPM scores were related to overall survival (OS) and disease-free survival (DFS). Univariate and multivariate Cox regression analyses identified ctBVL, ctLVI, ctOPM scores as independent risk factors for GC prognosis. In multivariate analysis, the three sign scores were related to DFS (p < 0.05), with ctBVL (hazard ratio (HR) = 1.980, 95% CI: 1.336–2.933), ctLVI (HR = 1.502, 95% CI: 1.336–2.933), and ctOPM (HR = 1.182, 95% CI: 0.886–1.578). The three scores were also correlated with OS (p < 0.05), ctBVL (HR = 2.003, 95% CI: 1.278–3.139), ctLVI (HR = 1.523, 95% CI:1.055–2.200) and ctOPM (HR = 1.289, 95% CI: 1.013–1.770).

Conclusion

CtBVL, ctLVI, and ctOPM scores are valuable prognostic indicators in gastric cancer, influencing both OS and DFS.

Key Points

Question To study whether the ctBVL, ctLVI, and ctOPM scores assessed by preoperative enhanced CT imaging can predict the survival outcomes of patients.

Findings CtBVL, ctLVI, and ctOPM scores, assessed via preoperative enhanced CT imaging, are associated with worse survival outcomes when elevated.

Clinical relevance CtBVL, ctLVI, and ctOPM scores may help guide personalized follow-up plans. Patients with higher scores might require closer monitoring and more aggressive treatment.

Graphical Abstract