Influence of visceral adipose tissue on the accuracy of tumor T-staging of gastric cancer in preoperative CT

Abstract

Objectives: To evaluate the impact of the visceral adipose tissue (VAT) area and density on the accuracy of tumor T-staging of gastric cancer in preoperative computed tomography (CT).

Methods: This study included 136 patients with gastric cancer in our research center from January 2021 to June 2022. The patients were divided into two groups based on their postoperative pathological results: accurate-staging (matched T-staging evaluated by preoperative CT and postoperative pathology) and inaccurate-staging (unmatched T-staging evaluated by preoperative CT and postoperative pathology) groups. Preoperative CT was performed to assess the VAT area and density, and logistic regression was employed to evaluate the effect of VAT on the accuracy of preoperative-CT-evaluated T-staging of patients with gastric cancer.

Results: The accurate-staging group had a significantly higher VAT area (134.64 ± 70.55 cm² vs 95.44 ± 66.18 cm², P = 0.003) and significantly lower VAT density (-95.05 ± 12.28 Hounsfield Units [HU] vs - 89.68 ± 13.26 HU, P = 0.027) than the inaccurate-staging group. A low VAT area (P = 0.002) and tumor located in the upper stomach (P = 0.019) were significantly associated with and were independent risk factors for the error of CT-evaluated T-staging. Compared to a VAT area ≥ 81.04 cm², which was used as a reference, the odds ratio (OR) of a VAT area < 81.04 cm² for the probability of T-staging mis-assessment was 4.455 (95% confidence interval [CI]: 1.728-11.485).

Conclusions: A low VAT area in patients with gastric cancer had adverse effects on preoperative CT-evaluated T-staging.

Keywords: Gastric cancer; Postoperative complications; Visceral fat.