Dual-energy CT for predicting progression-free survival of locally advanced gastric cancer after gastrectomy: Insights into tumor angiogenesis

Yiyang Liu ¹, Yusong Chen ¹, Jiao Shu ²

¹Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China; Henan International Joint Laboratory of Medical Imaging, Zhengzhou, China; Henan Key Laboratory of Image Diagnosis and Treatment for Digestive System Tumor, Zhengzhou, China; Henan Key Laboratory of CT Imaging, Zhengzhou, China; The First Clinical School of Medicine, Zhengzhou University, Zhengzhou, 450052, China.
²The First Clinical School of Medicine, Zhengzhou University, Zhengzhou, 450052, China; Department of Pathology, The First Affiliated Hospital of Zhengzhou University, China.
³Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China; Henan International Joint Laboratory of Medical Imaging, Zhengzhou, China; Henan Key Laboratory of Image Diagnosis and Treatment for Digestive System Tumor, Zhengzhou, China; Henan Key Laboratory of CT Imaging, Zhengzhou, China.
⁴Department of Radiology, The Second Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, 014030, China.
⁵Department of Pathology, The First Affiliated Hospital of Zhengzhou University, China.
⁶Department of Pathology, The Second Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, China.
⁷Department of Medical Oncology, The Second Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, China.
⁸Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.

⁰Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China; Henan International Joint Laboratory of Medical Imaging, Zhengzhou, China; Henan Key Laboratory of Image Diagnosis and Treatment for Digestive System Tumor, Zhengzhou, China; Henan Key Laboratory of CT Imaging, Zhengzhou, China; The First Clinical School of Medicine, Zhengzhou University, Zhengzhou, 450052, China.

European Journal of Surgical Oncology : the Journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology +

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April 13, 2025

View abstract on PubMed

Summary

Dual-energy CT (DECT) identified preoperative risk factors like arterial enhancement fraction for progression-free survival (PFS) in locally advanced gastric cancer (LAGC). This combined DECT and clinical data accurately predicts PFS and is linked to tumor angiogenesis.

Area Of Science

Radiology and Imaging
Oncology
Surgical Pathology

Background

Locally advanced gastric cancer (LAGC) poses significant challenges for prognosis prediction.
Accurate preoperative assessment of progression-free survival (PFS) is crucial for treatment planning in LAGC patients undergoing gastrectomy.
Dual-energy CT (DECT) offers advanced imaging capabilities for characterizing tumor microenvironment and predicting outcomes.

Purpose Of The Study

To identify preoperative dual-energy CT (DECT)-derived independent risk factors for progression-free survival (PFS) in locally advanced gastric cancer (LAGC) patients.
To evaluate the prognostic performance of DECT-derived parameters, alone and in combination with clinical data, for predicting PFS.
To explore the histopathologic underpinnings of DECT-based parameters related to PFS.

Main Methods

Prospective study involving 120 LAGC patients undergoing preoperative DECT and gastrectomy.
Collection of clinical data, DECT-derived morphological characteristics, and iodine-related parameters.
Univariate and multivariate analyses, C-index, time-dependent ROC analysis, and Kaplan-Meier curves were used to identify risk factors and evaluate prognostic performance.

Main Results

Age, arterial enhancement fraction (AEF), serosal invasion, and tumor thickness were identified as independent preoperative risk factors for PFS (p < 0.05).
A combined parameter incorporating these factors achieved a C-index of 0.75, outperforming individual factors and postoperative staging (C-index = 0.67).
The combined parameter demonstrated good predictive accuracy for 0.5-, 1-, and 2-year PFS (AUCs 0.72-0.77) and was associated with tumor microvessel density (r = 0.31, p < 0.001).

Conclusions

The combination of DECT-derived imaging features, iodine parameters, and clinical data accurately stratifies PFS in LAGC patients preoperatively.
DECT shows promise for preoperative PFS evaluation in LAGC patients undergoing gastrectomy.
The identified DECT parameters are associated with tumor angiogenesis, providing insights into the biological basis of PFS.

Keywords:

Microvascular density Progression-free survival Stomach neoplasms Tomography X-ray computer