内脏脂肪对进展期胃癌术前分期评估准确性的影响  

The Impact of Visceral Adipose Tissue on the Accuracy of Preoperative Staging Evaluation for Advanced Gastric Cancer

作　　者：李莉明[1,2] 王睿 肖晓燕[1] 黄文鹏 姚洋 高剑波 LI Liming;WANG Rui;XIAO Xiaoyan(Department of Radiology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan Province 450052 P.R.China)

机构地区：[1]郑州大学第一附属医院放射科,450052 [2]河南省呼吸与危重症学会,郑州450052 [3]西安交通大学第一附属医院,710061 [4]北京大学第一医院,100034 [5]河南省消化肿瘤影像重点实验室,郑州450052

出　　处：《临床放射学杂志》2025年第2期333-337,共5页Journal of Clinical Radiology

基　　金：河南省“科创中原”青年人才托举工程资助项目(编号:2023HYTP039);河南省医学科技攻关联合共建资助项目(编号:LHGJ20220409);河南省高等学校重点科研项目(编号:23A320059);河南省科技攻关资助项目(编号:242102311026)。

摘　　要：目的探讨内脏脂肪的CT特征对胃癌术前T、N分期评估准确性的影响。方法回顾性搜集行手术治疗的进展期胃癌患者222例,在CT图像中获取患者L 2/L 3层面的内脏脂肪(VAT)的面积和平均CT值。由诊断医师在术前的CT图像中评估胃癌的T、N分期。以病理分期为标准,分析影像T、N分期的准确性。分别比较T、N分期评估准确组和错误组的临床和影像特征。多因素回归分析筛选影响评估准确性的独立因素。结果T分期评估的准确性约64.41%,pT2、pT3、pT4分期评估的准确性分别约55.88%、66.67%、64.15%。N分期评估的准确性约37.84%,pN0、pN1、pN2、pN3分期评估的准确性分别约63.93%、42.5%、32.43%、19.05%。VAT的面积在T分期和N分期评估准确组和错误组差异有统计学意义(P=0.013,0.005),VAT的密度在T分期和N分期评估准确组和错误组差异有统计学意义(P=0.001,0.008)。多因素分析显示VAT密度是影响T分期和N分期评估准确性的独立因素。结论VAT的面积和密度影响胃癌术前T分期、N分期评估的准确性。Objective To explore the impact of CT features of visceral adipose tissue(VAT)on the accuracy of preoperative T and N staging of gastric cancer.Methods The CT images of 222 patients who underwent gastrectomy were analyzed retrospectively.The area and attenuation values of VAT at L 2/L 3 level were achieved.The preoperative CT and pathological Tand N staging of gastric cancer were compared.Compared the clinical and VAT characteristics of accurate staging group and mistaken staging group.Multivariate logistic regressions were used to analysis the independent factors affecting the accuracy of staging.Results The accuracy of Tstaging was 64.41%,with 55.88%in pT2,66.67%in pT3,64.15%in pT4.The accuracy of Nstaging was 37.84%,with 63.93%in pN0,42.5%in pN1,32.43%in pN2,19.05%in pN3.The area of VAT showed a significant difference between the accurate staging group and the mistaken staging group of the T and N staging(P=0.013,0.005).The density of VAT showed a significant difference between the accurate staging group and the mistaken staging group of the T and N staging(P=0.001,0.008).Multivariate logistic regression analysis showed the density of VAT was an independent predictor of T and N staging accuracy.Conclusion The area and density of VAT affect the preoperative accuracy of T staging and N staging evaluations of gastric cancer.

关 键 词：胃癌 体层摄影术 X线计算机 T分期 N分期 内脏脂肪 

分 类 号：R735.2[医药卫生—肿瘤] R730.44[医药卫生—临床医学]