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.	羅會芹, 何義富. 晚期胃癌轉化治療策略的研究進展. 腫瘤預防與治療, 2019, 32(8): 718-724.
2.	周斌, 陳環球. Ⅳ期胃癌轉化治療的實踐. 中國腫瘤外科雜志, 2016, 8(4): 217-222.
3.	劉浩, 何陽科, 宋旭彤, 等. FOLFOX4、SOX 化療方案治療晚期胃癌的療效及對血清生物活性因子及預后的影響. 癌癥進展, 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.	倪宗瓚. 衛生統計學. 第 4 版, 北京: 人民衛生出版社, 2000: 165.
7.	楊陽, 唐立. MSCT 三期增強掃描對胃淋巴瘤、胃間質瘤與進展期胃癌的鑒別診斷. 中國 CT 和 MRI 雜志, 2019, 17(10): 120-123.
8.	史振乾, 史富磊. MSCT 多平面重建技術在胃癌診治中的應用研究. 中國 CT 和 MRI 雜志, 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. 多層螺旋 CT 在進展期胃癌術前 TNM 分期中的應用價值. 安徽醫藥, 2018, 22(5): 921-923.
12.	趙群, 李勇, 胡子龍, 等. 多層螺旋 CT 對胃癌術前分期及腫瘤最長徑的評估價值. 中華胃腸外科雜志, 2015, 18(3): 227-231.
13.	姜躍龍, 吳曦, 王征, 等. 環掃超聲胃鏡在進展期胃癌術前 TN 分期中的應用分析. 中華消化內鏡雜志, 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.	唐雪蓮, 藺蓉, 韓超群, 等. 超聲內鏡在胃癌 TNM 分期中的作用. 世界華人消化雜志, 2016, 24(25): 3641-3646.
18.	黃健, 魏桂花, 劉琴. 超聲內鏡聯合 MRI 掃描在胃癌術前分期中的應用研究. 中國醫學創新, 2015, 12(29): 6-8.
19.	王會豐, 劉鑫, 韓文, 等. 超聲內鏡、MSCT 掃描在胃癌術前診斷和分期中的應用分析. 中國 CT 和 MRI 雜志, 2019, 17(11): 120-122.
20.	林秉淞. 超聲內鏡與多層螺旋 CT 在胃癌術前分期中應用研究. 中國 CT 和 MRI 雜志, 2017, 15(8): 118-120, 127.
21.	王谷一, 趙振華, 楊建峰, 等. 64 排多層 CT 與超聲胃鏡在胃癌術前評估的對比研究. 全科醫學臨床與教育, 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.	武贊凱, 王宇, 張耕源, 等. 增強 CT 對進展期胃癌術前的評估價值. 中華普通外科學文獻: 電子版, 2016, 10(2): 133-137.
24.	王景宇, 冬冬, 戴春來, 等. 多層螺旋 CT 對胃癌淋巴結轉移的診斷價值. 中國醫學科學院學報, 2010, 32(6): 659-662.
25.	劉煒, 李小毅, 薛華丹, 等. CT 體積測量在進展期胃癌患者新輔助化療療效評價中的應用價值研究. 癌癥進展, 2010, 8(5): 420-424.

1. 羅會芹, 何義富. 晚期胃癌轉化治療策略的研究進展. 腫瘤預防與治療, 2019, 32(8): 718-724.
2. 周斌, 陳環球. Ⅳ期胃癌轉化治療的實踐. 中國腫瘤外科雜志, 2016, 8(4): 217-222.
3. 劉浩, 何陽科, 宋旭彤, 等. FOLFOX4、SOX 化療方案治療晚期胃癌的療效及對血清生物活性因子及預后的影響. 癌癥進展, 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. 倪宗瓚. 衛生統計學. 第 4 版, 北京: 人民衛生出版社, 2000: 165.
7. 楊陽, 唐立. MSCT 三期增強掃描對胃淋巴瘤、胃間質瘤與進展期胃癌的鑒別診斷. 中國 CT 和 MRI 雜志, 2019, 17(10): 120-123.
8. 史振乾, 史富磊. MSCT 多平面重建技術在胃癌診治中的應用研究. 中國 CT 和 MRI 雜志, 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. 多層螺旋 CT 在進展期胃癌術前 TNM 分期中的應用價值. 安徽醫藥, 2018, 22(5): 921-923.
12. 趙群, 李勇, 胡子龍, 等. 多層螺旋 CT 對胃癌術前分期及腫瘤最長徑的評估價值. 中華胃腸外科雜志, 2015, 18(3): 227-231.
13. 姜躍龍, 吳曦, 王征, 等. 環掃超聲胃鏡在進展期胃癌術前 TN 分期中的應用分析. 中華消化內鏡雜志, 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. 唐雪蓮, 藺蓉, 韓超群, 等. 超聲內鏡在胃癌 TNM 分期中的作用. 世界華人消化雜志, 2016, 24(25): 3641-3646.
18. 黃健, 魏桂花, 劉琴. 超聲內鏡聯合 MRI 掃描在胃癌術前分期中的應用研究. 中國醫學創新, 2015, 12(29): 6-8.
19. 王會豐, 劉鑫, 韓文, 等. 超聲內鏡、MSCT 掃描在胃癌術前診斷和分期中的應用分析. 中國 CT 和 MRI 雜志, 2019, 17(11): 120-122.
20. 林秉淞. 超聲內鏡與多層螺旋 CT 在胃癌術前分期中應用研究. 中國 CT 和 MRI 雜志, 2017, 15(8): 118-120, 127.
21. 王谷一, 趙振華, 楊建峰, 等. 64 排多層 CT 與超聲胃鏡在胃癌術前評估的對比研究. 全科醫學臨床與教育, 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. 武贊凱, 王宇, 張耕源, 等. 增強 CT 對進展期胃癌術前的評估價值. 中華普通外科學文獻: 電子版, 2016, 10(2): 133-137.
24. 王景宇, 冬冬, 戴春來, 等. 多層螺旋 CT 對胃癌淋巴結轉移的診斷價值. 中國醫學科學院學報, 2010, 32(6): 659-662.
25. 劉煒, 李小毅, 薛華丹, 等. CT 體積測量在進展期胃癌患者新輔助化療療效評價中的應用價值研究. 癌癥進展, 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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