The Preoperative Enhanced Degree of Contrast-enhanced CT Images: A Potential Independent Predictor in Gastric Adenocarcinoma Patients After Radical Gastrectomy

AIM: To discover the value of contrast-enhanced CT parameters in predicting the prognosis of gastric adenocarcinoma (GAC) patients after radical gastrectomy. METHODS: The patients with a clinical diagnosis of GAC were retrospectively enrolled. Two radiologists drew the regions of interest (ROIs) in CT images and measured the CT attenuate value (CAV) in each phase and the corrected CAV (cCAV) in each contrast-enhanced phase. Patients were divided into two groups (high/low-enhancement) according to receiver operating characteristic (ROC) curve. Kaplan–Meier curve and Cox proportional hazards regression analysis were performed to evaluate correlation between prognosis and variables. Subgroup analysis was used to further analyze the prognostic value of variables. RESULTS: In total 435 patients were included. According to ROC curve, the cCAV in delayed phase (DP-cCAV) with maximum AUC and Youden index was chosen. A total of 312 patients (71.7%) entered DP-cCAV(low) group and remaining 123 (28.3%) patients were in DP-cCAV(high) group. According to univariate (high vs low, HR=2.120, p<0.001) and multivariate (high vs low, HR=1.623, p<0.001) Cox regression analysis, the low-enhancement state was considered as an independent protective factor. Subgroup analysis was based on age, maximum diameter of tumor, differentiation, vascular invasion status, and TNM staging. In most subgroups, the overall survival (OS) of DP-cCAV(low) group was overwhelmingly satisfactory (all HR >1, expect TNM stage I, IV and differentiated type subgroups). CONCLUSION: The prognostic effectiveness of CT parameters as biomarkers for OS in GAC patients treated with radical gastrectomy has potential value.