Extent of arterial tumor enhancement measured with preoperative MDCT gastrography is a prognostic factor in advanced gastric cancer after curative resection

Abstract

Objective: The objective of this study was to investigate the correlation between pathologic findings and arterial tumor enhancement at MDCT gastrography of patients with a prognosis of advanced gastric cancer after curative resection.

Materials and methods: The cases of 41 patients with advanced gastric cancer (23 men, 18 women; age range, 35-92 years; median, 60 years) who underwent MDCT gastrography and optical endoscopy before surgery were retrospectively evaluated. Two radiologists reviewed virtual endoscopic and multiplanar reconstruction images to measure arterial phase CT values of the inner tumor margin and healthy gastric wall. They used consensus regions of interest on a cross-sectional image of the largest tumor diameter and then calculated tumor-to-normal wall enhancement ratio (TNR). Advanced gastric cancers were divided into high- and low-TNR groups with mean TNR as the cutoff. The correlations between groups and pathologic factors, patient survival, and mode of recurrence were studied.

Results: Multivariate logistic regression analysis showed that the arterial tumor enhancement ratio correlated with both microvessel density and lymphatic vessel invasion. The survival rate after curative resection was worse for the high-TNR group than for the low-TNR group. The rate of lymphatic and hematogenous recurrences was also higher in the high-TNR group. Multivariate survival analysis revealed that TNR was an independent prognostic factor.

Conclusion: The extent of arterial tumor enhancement correlated with tumor angiogenesis and lymphatic vessel invasion and was a useful prognostic indicator after curative resection in patients with advanced gastric cancer.