内脏脂肪组织对胃癌术前T分期准确性的影响

Impact of Visceral Adipose Tissue on the Accuracy of Preoperative T-Staging of Gastric Cancer

目的 探讨内脏脂肪组织对胃癌术前T分期准确性的影响。方法 回顾性连续搜集366例胃癌患者。根据胃癌术前CT图像T分期(cT)和术后病理T分期(pT)比较有无差异,将患者分为准确分期组和错误分期组。比较患者个体特征及在L_(2)/L_(3)层面、肿瘤最大层面下脂肪组织参数,包括性别、年龄、BMI、肿瘤最厚径、内脏脂肪组织(VAT)面积及平均CT值、皮下脂肪组织(SAT)面积及平均CT值。采用多因素Logistic回归对混杂因素进行调整后,筛选出影响胃癌术前T分期准确评估的独立危险因素。结果 366例患者中,164例(45%)为cT分期错误。准确分期组与错误分期组中,L_(2)/L_(3)层面下的VAT面积(SVAT1)、VAT平均CT值(DVAT1)、SAT面积(SSAT1)、SAT平均CT值(DSAT1)差异均具有统计学意义,肿瘤最大层面下的VAT面积(SVAT2)、VAT平均CT值(DVAT2)、SAT面积(SSAT2)差异均具有统计学意义(P<0.05)。多因素分析结果显示,L_(2)/L_(3)层面SVAT1(≥35.80 cm^(2))、肿瘤最大层面SVAT2(≥13.82 cm^(2))均为胃癌术前T分期准确评估的独立危险因素,其OR(95%CI)分别为2.771(1.243~6.181)、2.938 (1.635~5.277)。结论 L_(2)/L_(3)层面及肿瘤最大层面VAT面积均是胃癌术前精准评估T分期的重要因素。

Objective To investigate the effect of visceral adipose tissue on the accuracy of preoperative T-staging of gastric cancer.Methods 366 patients with gastric cancer who were treated and treated were retrospectively collected.According to the difference between clinical T stage(cT)and postoperative pathological T stage(pT),patients with gastric cancer were divided into accurate-and mis-staging groups.Compare individual characteristics of patients and adipose tissue parameters at L_(2)/L_(3) level and maximum tumor level,including gender,age,BMI,thickest tumor diameter,visceral adipose tissue(VAT)area and density,subcutaneous adipose tissue(SAT)area and density.Multivariate logistic regression was used to determine the independent factors affecting the accuracy of cT staging.Results Among 366 patients,164(45%)were wrong in cT staging.There were statistically significant differences in VAT area(SVAT1),VAT average density(DVAT1),SAT area(SSAT1)and SAT average density(DSAT1)at L_(2)/L_(3) level between the accurate-staging group and the mis-staging group.The difference of VAT area(SVAT2),average VAT CT value(DVAT2)and SAT area(SSAT2)at the largest tumor level was also statistically significant(P<0.05).Multivariate analysis results showed that L_(2)/L_(3) level SVAT1(≥35.80 cm^(2))and the largest tumor level SVAT2(≥13.82 cm^(2))were independent risk factors for accurate evaluation of preoperative T-staging of gastric cancer.The OR(95%CI)were 2.771(1.243-6.181)and 2.938(1.635-5.277),re-spectively.Conclusion Both L_(2)/L_(3) level and VAT area of the largest tumor level are important factors for accurate preoperative T-staging assessment of gastric cancer.