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. 2025 Aug 19;25(1):334.
doi: 10.1186/s12880-025-01872-1.

Enhancing risk stratification in diabetic gastric cancer: muscle-fat ratio from photon-counting CT as a predictor of postoperative complications

Shuangxiang Lin  1 , Yuchen Jin  1 , Mengxi Xu  1 , Shuyue Wang  1 , Weisheng Yao  2 , Jiaxing Wu  3 , Xinhong Wang #  1 , Jianzhong Sun  4
Affiliations

Enhancing risk stratification in diabetic gastric cancer: muscle-fat ratio from photon-counting CT as a predictor of postoperative complications

Shuangxiang Lin et al. BMC Med Imaging. .

Abstract

Background: In diabetic gastric cancer patients, body composition (skeletal muscle–to–fat ratio, MFR) may influence surgical outcomes. We evaluated whether Photon-counting CT (PCD-CT) derived MFR predicts major postoperative complications, reflecting its value in perioperative risk stratification.

Methods: A retrospective analysis of 134 gastric cancer patients with type 2 diabetes was conducted. Preoperative PCD-CT scans assessed body composition. Logistic regression models identified predictors of poor postoperative outcomes, defined by major postoperative complications. The predictive accuracy of models incorporating clinical variables and MFR was evaluated using receiver operating characteristic curves, integrated Discrimination Improvement (IDI), and net Reclassification Improvement (NRI).

Results: Patients who developed major complications (n = 35) had significantly lower skeletal muscle area (45.5 vs. 56.2 cm²; P < 0.01) and higher fat accumulation. Abnormal MFR (0.34–0.57)was a strong predictor of poor outcomes (OR = 1.94, 95% CI: 1.17–2.58, p < 0.01) compared to patients without complications (n = 99). The model combining clinical variables with MFR had the best performance (AUC = 0.75, sensitivity = 0.74, specificity = 0.71) in predicting major complications, outperforming a model based solely on clinical factors. It also showed substantial improvements in predictive accuracy, with an NRI of 0.52 (p < 0.01) and an IDI of 0.09 (p < 0.01).

Conclusion: MFR, quantified by PCD-CT, is a reliable and accurate biomarker for identifying diabetic gastric cancer patients at higher risk of major postoperative complications. MFR demonstrates strong predictive value for adverse surgical outcomes, reinforcing its role in perioperative risk stratification.

Clinical trial number: Not applicable.

Supplementary Information: The online version contains supplementary material available at 10.1186/s12880-025-01872-1.

Keywords: Diabetic; Gastric cancer; Muscle-to‐fat ratio; Photon-counting CT.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This retrospective study was approved by the Human Research Ethics Committee of the Second Affiliated Hospital, Zhejiang University School of Medicine (Approval No: IR2024488), adhering to the Declaration of Helsinki. The requirement for informed consent was waived because of the retrospective nature of the study. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of study participant eligibility
Fig. 2
Fig. 2
Body Composition measurement by photon-counting CT. Purple represents subcutaneous adipose tissue, yellow represents visceral adipose tissue, and red represents skeletal muscle
Fig. 3
Fig. 3
Group comparisons in different prognoses in body composition parameters are shown in (A) SM, (B) SMBMI, (C) SMBSA, (D) SF, (E) SFBMI, (F)SFBSA, (G)VF, (H) VFBMI and (I) VFBSA. SM, Skeletal muscle; SMBMI, Skeletal muscle index BMI; SMBSA, Skeletal muscle index BSA; SF, Subcutaneous Fat; SF BMI, Subcutaneous Fat index BMI; SF BSA, Subcutaneous Fat index BSA; VF, Visceral Fat; VF BMI, Visceral Fat index BMI; VF BSA, Visceral Fat index BSA
Fig. 4
Fig. 4
Group comparisons in Different prognoses between the normal and abnormal muscle-fat ratio with body composition parameters are shown in (A) SM, (B) SMBMI, (C) SMBSA, (D) SF, (E) SFBMI, (F)SFBSA, (G)VF, (H) VFBMI and (I) VFBSA. SM, Skeletal muscle ; SMBMI, Skeletal muscle index BMI; SMBSA, Skeletal muscle index BSA; SF, Subcutaneous Fat; SF BMI, Subcutaneous Fat index BMI; SF BSA, Subcutaneous Fat index BSA; VF, Visceral Fat; VF BMI, Visceral Fat index BMI; VF BSA, Visceral Fat index BSA; MFR, Muscle-to‐fat ratio
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References

    1. Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. Cancer J Clin. 2024;74(3):229–63. - PubMed
    1. Chen S, Cao Z, Prettner K, et al. Estimates and projections of the global economic cost of 29 cancers in 204 countries and territories from 2020 to 2050. JAMA Oncol. 2023;9(4):465–72. - PMC - PubMed
    1. Singh D, Vignat J, Lorenzoni V, et al. Global estimates of incidence and mortality of cervical cancer in 2020: a baseline analysis of the WHO global cervical cancer elimination initiative. Lancet Global Health. 2023;11(2):e197–206. - PMC - PubMed
    1. Hong SH, Noh E, Kim J, et al. Fasting plasma glucose variability and gastric cancer risk in individuals without diabetes mellitus: A nationwide Population-Based cohort study. Clin Translational Gastroenterol. 2020;11(9):e00221. - PMC - PubMed
    1. Yu Z, Liang C, Li R, et al. The impact of diabetes mellitus on short and long term outcomes in patients with gastric cancer following radical surgery: a retrospective cohort study with propensity score matching. BMC Cancer. 2024;24(1):1461. - PMC - PubMed

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