内脏脂肪组织对胃癌隐匿性腹膜转移的预测价值

Predictive value of visceral adipose tissue in occult peritoneal metastasis of gastric cancer

目的探讨内脏脂肪组织(VAT)在胃癌隐匿性腹膜转移(OPM)中的预测价值。方法回顾性收集2018年10月至2021年10月郑州大学第一附属医院收治的93例胃癌患者,患者均无典型腹膜转移CT征象。根据腹腔镜探查结果将患者分为OPM组(31例)与非OPM组(62例)。记录患者临床、病理及CT征象。分别测量CT图像中胃癌病灶最大层面以下15、25 mm范围的脂肪组织参数,包括VAT和皮下脂肪组织的体积、平均CT值及标准差。采用独立样本t检验、Wilcoxon秩和检验、χ2检验或Fisher确切概率法比较OPM与非OPM组间的临床、病理及CT图像参数的差异。采用多因素logistic回归分析筛选胃癌OPM的独立危险因素并建立联合模型,以受试者操作特征曲线评价各个指标及联合模型预测胃癌OPM的效能。结果OPM与非OPM组间年龄、病理类型、CA125、腹腔积液、cT分期、病灶最厚径、15 mm VAT平均CT值、25 mm VAT平均CT值的差异有统计学意义(P<0.05)。多因素分析结果显示,腹腔积液、cT分期、25 mm VAT平均CT值是胃癌OPM的独立危险因素,其OR(95%CI)分别为4.940(1.287~18.967)、4.284(1.270~14.455)、1.149(1.013~1.303),建立联合模型。腹腔积液、cT分期、25 mm VAT平均CT值、15 mm VAT平均CT值及联合模型的曲线下面积(AUC)分别为0.685、0.718、0.703、0.674和0.813,联合模型与上述4个单一指标比较AUC差异均有统计学意义(Z=2.98、2.63、2.09、2.54,P=0.003、0.009、0.037、0.011)。结论腹腔积液、cT分期、25 mm VAT平均CT值是胃癌OPM的独立危险因素,基于以上3个指标建立的logistic回归模型,预测胃癌OPM的效能最佳。

Objective To investigate the predictive value of visceral adipose tissue(VAT)in occult peritoneal metastasis(OPM)of gastric cancer.Methods A total of 93 patients with gastric cancer admitted to the First Affiliated Hospital of Zhengzhou University from October 2018 to October 2021 were retrospectively collected.None of the patients had typical peritoneal metastasis on CT.Patients were divided into OPM group(31 cases)and non-OPM group(62 cases)according to laparoscopic exploration.The clinical,pathological and CT features were recorded.The parameters related to adipose tissue(VAT and subcutaneous adipose tissue)within the range of 15 mm and 25 mm below the largest layer of gastric cancer lesions in preoperative CT images were measured,including the volume,average CT attenuation and standard deviation.The independent-sample t test,Wilcoxon rank-sum test,χ2 test or Fisher′s exact probability were used to compare the clinical,pathological and CT imaging parameters between OPM and non-OPM groups.Multivariate logistic regression analysis was used to explore the independent risk factors for OPM of gastric cancer and establish a combined model.The receiver operating characteristic curve was used to evaluate the efficacy of each indicator and the combined model in predicting OPM of gastric cancer.Results There were statistically significant differences in age,pathological type,CA125,ascites,cT stage,the thickest diameter of lesion,average CT attenuation of 15 mm VAT and 25 mm VAT between the OPM group and the non-OPM group(P<0.05).Multivariate analysis showed that ascites,cT stage and average CT attenuation of 25 mm VAT were independent risk factors for OPM of gastric cancer,with the OR(95%CI)of 4.940(1.287-18.967),4.284(1.270-14.455),and 1.149(1.013-1.303),respectively.A combined model was established.The area under the curve(AUC)of ascites,cT stage,average CT attenuation of 25 mm VAT,average CT attenuation of 15 mm VAT and combined model were 0.685,0.718,0.703,0.674 and 0.813,respectively.There were statistically significant differences in AUC between the combined model and each four single indicators above(Z=2.98,2.63,2.09,2.54,P=0.003,0.009,0.037,0.011).Conclusions The ascites,cT stage and average CT attenuation of 25 mm VAT are independent risk factors for OPM in gastric cancer.The combined model based on the above three indicators has the best performance in predicting OPM in gastric cancer.