| Objective The blood supply of the stomach is rich,and the growth and progress of the tumor are based on the blood supply.Due to the proliferation of the tumor or metastatic focus,the operation of locally advanced gastric cancer is difficult and the prognosis is poor.In addition to surgical treatment,local advanced gastric cancer also requires chemotherapy.Chemotherapy drugs are effective by infiltrating tumor tissue,which also relies on blood supply.Methods to preoperatively evaluate blood supply are rare.Histological methods can only observe the ability of angiogenesis in tumor tissues,but many of those new blood vessels are immature and do not circularly function.Multi-detector computed tomography(MDCT)can evaluate the blood supply of gastric cancer by observing the Iodine contrast enhancement of tumor and surrounding tissues or blood vessel.Besides,the relationship between tumor blood supply and the efficacy of preoperative chemotherapy can be analyzed,and reference for individualized treatment for locally advanced gastric cancer patients may be provided.Methods Since September 2013,the patients with locally advanced gastric cancer admitted to our hospital have been studied.After plain scanning and enhanced MDCT examination of cancer and metastatic lymph nodes with adjacent organs and blood vessels,radical gastrectomy was performed for those who could be resected,while preoperative chemotherapy was performed for those who could not be resected,followed by subsequent treatment.CT values in lesions in both portal venous and plain phase were calculated and adjusted to aorta CT(AACT)values.The preoperative chemotherapy group was administered intra-arterial and intravenous chemotherapy.Response Evaluation Criteria In Solid Tumors Version 1.1(RECIST 1.1)was used to evaluate the imaging response of chemotherapy and histological standards of the Japanese Gastric Cancer Association(JGCA)were applied to evaluate the pathological chemotherapeutic response.Results By November 2017,300 cases with gastric cancer were enrolled,including 179 patients with direct surgery and 121 patients with preoperative chemotherapy.The ages of 300 patients were 59.03±10.82 years,and AACT value was 0.5741 ± 0.1183.There was no significant difference in AACT values of tumors in terms of gender,tumor location and general type(P>0.05).In terms of histological type,there were statistically significant differences in AACT values of pathological type between well and poor differentiated adenocarcinoma(P=0.024),between well differentiated adenocarcinoma and signet ring cell carcinoma(P=0.001)and between poor differentiated adenocarcinoma and signet ring cell carcinoma(P=0.030),respectively.There were 87 cases in tumor response group with AACT value of 0.6286±0.1922,while 34 in non-response group with AACT value of 0.4945±0.2451,and significant difference in AACT value between two groups was present(P<0.001).According to the results of preoperative chemotherapy group,receiver-operating characteristic curve(ROC curve)was drew and the area under the ROC curve was 0.758,which was significantly showed that the evaluation of blood supply might have an effect on the assessment of efficacy of preoperative chemotherapy for gastric cancer.The threshold 0.5164 of AACT value,which was calculated by Youden Index,had sensitivity 80.5% and specificity 67.6% of chemotherapy effect respectively.Conclusions The blood supply of gastric cancer is related to its histopathological type.The well differentiated gastric cancer would have more abundant blood supply.Locally advanced gastric cancer with high AACT value may have abundant tumor blood supply and tumor size may be reduced and stage may be degraded,even pathological remission being achieved,after preoperative chemotherapy. |
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