Clinical application of multi-slice spiral CT in the judgment of N stage and lymph node metastasis after conversion therapy for advanced gastric cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

YU Hualong ,  YAO Zengwu , ZHANG Yifei , HU Jinchen , WANG Xixun , ZHANG Zhenbin , ZHANG Menglai , CUI Weihao , JIA Rongbao ,  JIANG Lixin

The First Department of Gastrointestinal Surgery, Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong 264000, P. R. China;

Corresponding author：

YAO Zengwu, Email: yzw1986yzw@126.com; JIANG Lixin, Email: jianglixin1969@hotmail.com

Keywords：

advanced gastric cancer; multi-slice spiral CT; transformation therapy; lymph node metastasis; N stage

DOI：

10.7507/1007-9424.201907099

Video：

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Objective To explore the value of multi-slice spiral CT (MSCT) in the judgment of N stage and lymph node metastasis of patients with advanced gastric cancer who underwent surgery after transformation therapy.Methods Clinical data of 27 patients with advanced gastric cancer who underwent surgery after transformation therapy, form July 2017 to July 2019 in Affiliated Yantai Yuhuangding Hospital of Qingdao University were analyzed retrospectively, and all of patients underwent SOX regimen transformation therapy. The MSCT enhanced scan was performed before operation, and the postoperative pathology was used as the gold standard. The preoperative N stage and lymph node metastasis groups were evaluated by MSCT enhanced scan and compared with the pathological results.Results Before the operation, MSCT was used to evaluate the lymph node metastasis of the patients with advanced gastric cancer after transformation therapy, and compared with the lymph nodes metastasis of the corresponding pathological results, the accuracy rates of lymph node groups in No.1, No.3, No.5, No.6, No.7, No.8, and No.16 were 77.78% (21/27), 81.48% (22/27), 85.19% (23/27), 88.89% (24/27), 85.19% (23/27), 74.07% (20/27), and 96.30% (26/27), respectively. Compared with pathological results, the total accuracy of N stage after transformation therapy that evaluated by MSCT was 62.96% (17/27), with the Kappa coefficient was 0.419 (P=0.003).Conclusions MSCT has high accuracy and consistency for the N stage of advanced gastric cancer after transformation therapy. Besides, MSCT has a certain diagnostic rate for lymph node metastasis in patients with advanced gastric cancer in lymph node groups of No.1, No.3, No.5, No.6, No.7, No.8, and No.16.

Citation： YU Hualong, YAO Zengwu, ZHANG Yifei, HU Jinchen, WANG Xixun, ZHANG Zhenbin, ZHANG Menglai, CUI Weihao, JIA Rongbao, JIANG Lixin. Clinical application of multi-slice spiral CT in the judgment of N stage and lymph node metastasis after conversion therapy for advanced gastric cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2020, 27(2): 158-162. doi: 10.7507/1007-9424.201907099 Copy

1.	罗会芹, 何义富. 晚期胃癌转化治疗策略的研究进展. 肿瘤预防与治疗, 2019, 32(8): 718-724.
2.	周斌, 陈环球. Ⅳ期胃癌转化治疗的实践. 中国肿瘤外科杂志, 2016, 8(4): 217-222.
3.	刘浩, 何阳科, 宋旭彤, 等. FOLFOX4、SOX 化疗方案治疗晚期胃癌的疗效及对血清生物活性因子及预后的影响. 癌症进展, 2019, 17(11): 1282-1285, 1309.
4.	Amin MB, Greene FL, Edge SB, et al. The Eighth Edition AJCC Cancer Staging Manual: continuing to build a bridge from a population-based to a more “personalized” approach to cancer staging. CA Cancer J Clin, 2017, 67(2): 93-99.
5.	D’Elia F, Zingarelli A, Palli D, et al. Hydro-dynamic CT preoperative staging of gastric cancer: correlation with pathological findings. A prospective study of 107 cases. Eur Radiol, 2000, 10(12): 1877-1885.
6.	倪宗瓒. 卫生统计学. 第 4 版, 北京: 人民卫生出版社, 2000: 165.
7.	杨阳, 唐立. MSCT 三期增强扫描对胃淋巴瘤、胃间质瘤与进展期胃癌的鉴别诊断. 中国 CT 和 MRI 杂志, 2019, 17(10): 120-123.
8.	史振乾, 史富磊. MSCT 多平面重建技术在胃癌诊治中的应用研究. 中国 CT 和 MRI 杂志, 2017, 15(7): 110-112, 119.
9.	Yamaguchi K, Yoshida K, Tanahashi T, et al. The long-term survival of stage Ⅳ gastric cancer patients with conversion therapy. Gastric Cancer, 2018, 21(2): 315-323.
10.	Park SR, Kim MJ, Ryu KW, et al. Prognostic value of preoperative clinical staging assessed by computed tomography in resectable gastric cancer patients: a viewpoint in the era of preoperative treatment. Ann Surg, 2010, 251(3): 428-435.
11.	邵世虎, 曾小松, 夏宏林, 等. 多层螺旋 CT 在进展期胃癌术前 TNM 分期中的应用价值. 安徽医药, 2018, 22(5): 921-923.
12.	赵群, 李勇, 胡子龙, 等. 多层螺旋 CT 对胃癌术前分期及肿瘤最长径的评估价值. 中华胃肠外科杂志, 2015, 18(3): 227-231.
13.	姜跃龙, 吴曦, 王征, 等. 环扫超声胃镜在进展期胃癌术前 TN 分期中的应用分析. 中华消化内镜杂志, 2017, 34(6): 394-399.
14.	Kwee RM, Kwee TC. Imaging in local staging of gastric cancer: a systematic review. J Clin Oncol, 2007, 25(15): 2107-2116.
15.	Sun ZQ, Yan G, Ge YX, et al. Can low-dose CT perfusion imaging accurately assess response of advanced gastric cancer with neoadjuvant chemotherapy? J Xray Sci Technol, 2017, 25(6): 981-991.
16.	Liu S, Shi H, Ji C, et al. Preoperative CT texture analysis of gastric cancer: correlations with postoperative TNM staging. Clin Radiol, 2018, 73(8): 756.e751-756.e759.
17.	唐雪莲, 蔺蓉, 韩超群, 等. 超声内镜在胃癌 TNM 分期中的作用. 世界华人消化杂志, 2016, 24(25): 3641-3646.
18.	黄健, 魏桂花, 刘琴. 超声内镜联合 MRI 扫描在胃癌术前分期中的应用研究. 中国医学创新, 2015, 12(29): 6-8.
19.	王会丰, 刘鑫, 韩文, 等. 超声内镜、MSCT 扫描在胃癌术前诊断和分期中的应用分析. 中国 CT 和 MRI 杂志, 2019, 17(11): 120-122.
20.	林秉淞. 超声内镜与多层螺旋 CT 在胃癌术前分期中应用研究. 中国 CT 和 MRI 杂志, 2017, 15(8): 118-120, 127.
21.	王谷一, 赵振华, 杨建峰, 等. 64 排多层 CT 与超声胃镜在胃癌术前评估的对比研究. 全科医学临床与教育, 2016, 14(3): 256-259, 283.
22.	Pan Z, Zhang H, Yan C, et al. Determining gastric cancer resectability by dynamic MDCT. Eur Radiol, 2010, 20(3): 613-620.
23.	武赞凯, 王宇, 张耕源, 等. 增强 CT 对进展期胃癌术前的评估价值. 中华普通外科学文献: 电子版, 2016, 10(2): 133-137.
24.	王景宇, 冬冬, 戴春来, 等. 多层螺旋 CT 对胃癌淋巴结转移的诊断价值. 中国医学科学院学报, 2010, 32(6): 659-662.
25.	刘炜, 李小毅, 薛华丹, 等. CT 体积测量在进展期胃癌患者新辅助化疗疗效评价中的应用价值研究. 癌症进展, 2010, 8(5): 420-424.

1. 罗会芹, 何义富. 晚期胃癌转化治疗策略的研究进展. 肿瘤预防与治疗, 2019, 32(8): 718-724.
2. 周斌, 陈环球. Ⅳ期胃癌转化治疗的实践. 中国肿瘤外科杂志, 2016, 8(4): 217-222.
3. 刘浩, 何阳科, 宋旭彤, 等. FOLFOX4、SOX 化疗方案治疗晚期胃癌的疗效及对血清生物活性因子及预后的影响. 癌症进展, 2019, 17(11): 1282-1285, 1309.
4. Amin MB, Greene FL, Edge SB, et al. The Eighth Edition AJCC Cancer Staging Manual: continuing to build a bridge from a population-based to a more “personalized” approach to cancer staging. CA Cancer J Clin, 2017, 67(2): 93-99.
5. D’Elia F, Zingarelli A, Palli D, et al. Hydro-dynamic CT preoperative staging of gastric cancer: correlation with pathological findings. A prospective study of 107 cases. Eur Radiol, 2000, 10(12): 1877-1885.
6. 倪宗瓒. 卫生统计学. 第 4 版, 北京: 人民卫生出版社, 2000: 165.
7. 杨阳, 唐立. MSCT 三期增强扫描对胃淋巴瘤、胃间质瘤与进展期胃癌的鉴别诊断. 中国 CT 和 MRI 杂志, 2019, 17(10): 120-123.
8. 史振乾, 史富磊. MSCT 多平面重建技术在胃癌诊治中的应用研究. 中国 CT 和 MRI 杂志, 2017, 15(7): 110-112, 119.
9. Yamaguchi K, Yoshida K, Tanahashi T, et al. The long-term survival of stage Ⅳ gastric cancer patients with conversion therapy. Gastric Cancer, 2018, 21(2): 315-323.
10. Park SR, Kim MJ, Ryu KW, et al. Prognostic value of preoperative clinical staging assessed by computed tomography in resectable gastric cancer patients: a viewpoint in the era of preoperative treatment. Ann Surg, 2010, 251(3): 428-435.
11. 邵世虎, 曾小松, 夏宏林, 等. 多层螺旋 CT 在进展期胃癌术前 TNM 分期中的应用价值. 安徽医药, 2018, 22(5): 921-923.
12. 赵群, 李勇, 胡子龙, 等. 多层螺旋 CT 对胃癌术前分期及肿瘤最长径的评估价值. 中华胃肠外科杂志, 2015, 18(3): 227-231.
13. 姜跃龙, 吴曦, 王征, 等. 环扫超声胃镜在进展期胃癌术前 TN 分期中的应用分析. 中华消化内镜杂志, 2017, 34(6): 394-399.
14. Kwee RM, Kwee TC. Imaging in local staging of gastric cancer: a systematic review. J Clin Oncol, 2007, 25(15): 2107-2116.
15. Sun ZQ, Yan G, Ge YX, et al. Can low-dose CT perfusion imaging accurately assess response of advanced gastric cancer with neoadjuvant chemotherapy? J Xray Sci Technol, 2017, 25(6): 981-991.
16. Liu S, Shi H, Ji C, et al. Preoperative CT texture analysis of gastric cancer: correlations with postoperative TNM staging. Clin Radiol, 2018, 73(8): 756.e751-756.e759.
17. 唐雪莲, 蔺蓉, 韩超群, 等. 超声内镜在胃癌 TNM 分期中的作用. 世界华人消化杂志, 2016, 24(25): 3641-3646.
18. 黄健, 魏桂花, 刘琴. 超声内镜联合 MRI 扫描在胃癌术前分期中的应用研究. 中国医学创新, 2015, 12(29): 6-8.
19. 王会丰, 刘鑫, 韩文, 等. 超声内镜、MSCT 扫描在胃癌术前诊断和分期中的应用分析. 中国 CT 和 MRI 杂志, 2019, 17(11): 120-122.
20. 林秉淞. 超声内镜与多层螺旋 CT 在胃癌术前分期中应用研究. 中国 CT 和 MRI 杂志, 2017, 15(8): 118-120, 127.
21. 王谷一, 赵振华, 杨建峰, 等. 64 排多层 CT 与超声胃镜在胃癌术前评估的对比研究. 全科医学临床与教育, 2016, 14(3): 256-259, 283.
22. Pan Z, Zhang H, Yan C, et al. Determining gastric cancer resectability by dynamic MDCT. Eur Radiol, 2010, 20(3): 613-620.
23. 武赞凯, 王宇, 张耕源, 等. 增强 CT 对进展期胃癌术前的评估价值. 中华普通外科学文献: 电子版, 2016, 10(2): 133-137.
24. 王景宇, 冬冬, 戴春来, 等. 多层螺旋 CT 对胃癌淋巴结转移的诊断价值. 中国医学科学院学报, 2010, 32(6): 659-662.
25. 刘炜, 李小毅, 薛华丹, 等. CT 体积测量在进展期胃癌患者新辅助化疗疗效评价中的应用价值研究. 癌症进展, 2010, 8(5): 420-424.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical application of multi-slice spiral CT in the judgment of N stage and lymph node metastasis after conversion therapy for advanced gastric cancer

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