| AIMMultidetector-row computed tomography(MDCT)and serum tumor biomarkers are common methods to evaluate the lymph node metastasis and clinical staging of gastric cancer(GC)before operation.The purpose of this study was to investigate the clinical predictive value of MDCT and serum tumor biomarkers in lymph node metastasis of gastric cancer.MethodsThe preoperative clinicopathological data of 701 patients undergoing radical gastrectomy in the department of gastric oncology,Tianjin Medical University Affiliated Tumor Hospital in 2017 were retrospectively analyzed to evaluate the diagnostic value of MDCT and serum tumor biomarkers in lymph node metastasis staging of gastric cancer.Usingc~2 test analysis of the influencing factors of gastric cancer lymph node metastasis,Logistic regression analysis to analyses the independent risk factors for lymph node metastases of gastric cancer,P<0.05 is statistical significance;Individual and combine diagnostic values of MDCT and combined with tumor biomarkers on lymph node metastasis of gastric cancer were analyzed using that characteristic curve of the subject’s operation,the area of under the curve and the cut-off value.Results1.Of the 445 cases,306 were male and 139 female.Age range:17-82 years old,average age:57.8 years old;The total number of lymph nodes sent for postoperative examination was 18132,and the number of positive lymph nodes confirmed by pathological biopsy was 2,294.2.The results of multivariate logistic regression analysis showed that the diameter of the primary tumor≥4cm(OR:1.839,95%CI:1.113-3.038,p=0.017),the depth of tumor invasion was cT3(OR:0.157,95%CI:0.082-0.299,p=0.001),and the depth of tumor invasion was cT4(OR:0.419,95%CI:0.221-0.793,p=0.008).nerve invasion(OR:2.153,95%CI:1.023-4.534,p=0.043),vascular thrombus invasion(OR:1.655,95%CI:1.315-2.359,p=0.001),and soft tissue invasion(OR:2.020,95%CI:1.184-3.401,p=0.001)were independent risk factors for lymph node metastasis in gastric cancer.3.According to the ROC curve,the AUC of MDCT is 0.807,and the cut-off value of the maximum short diameter of lymph nodes in preoperative lymph node metastasis detected by MDCT scanning was 6.0mm.Compared with the postoperative pathological results of gastric cancer patients,the sensitivity,specificity and accuracy of predicting lymph node metastasis were 75.8%,75.6% and 75.7%,respectively.4.The AUC of CA-724,CA-199,CA-242 and CEA are 0.758,0.723,0.563 and 0.544,respectively.When diagnosing lymph node metastasis,CA-724 and CA-199 showed better diagnostic value than CA-242 and CEA,and the cut-off values of CA-724 and CA-199 were 2.69 U/ml and 25.1 U/ml,respectively.The sensitivity,specificity and accuracy of predicting lymph node metastasis were 65.9%,78.6%and 71.7%,respectively.5.When MDCT was combined with serum tumor biomarkers(including CA-724 and CA-199),the AUC was 0.849,and the sensitivity,specificity and accuracy of the diagnosis of lymph node metastasis were 89.3%,61.2%and 77.6%,respectively.Conclusion1.The risk of lymph node metastasis was higher in patients with preoperative evaluation of primary tumor diameter≥4cm and tumor invasion depth deeper than cT2.Nerve infiltration,vascular thrombus and soft tissue infiltration were independent risk factors for lymph node metastasis of gastric cancer.2.In MDCT scanning,the maximum short diameter of the lymph node was more than 6.0mm,which showed a better sensitivity than 10mm when it was used as the critical point for the diagnosis of lymph node metastasis on the premise that the specificity is not significantly reduced.3.For the diagnosis of gastric cancer lymph node metastasis,the cut-off values of CA-724 and CA-199 were 2.69 U/ml and 25.1 U/ml,respectively.CA-724 and CA-199 showed better diagnostic value than CA-242 and CEA.4.As an auxiliary examination,serum tumor markers combined with MDCT scanning can improve the sensitivity of preoperative lymph node metastasis in patients with gastric cancer and avoid the omission of preoperative diagnosis of lymph node metastasis. |
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