多排CT对胃癌腹膜转移术前预测的单中心大宗病例研究

目的探讨多排CT（MDCT）对胃癌腹膜转移术前预测的价值，基于胃癌MDCT征象探讨合理的腹腔镜探查指征。方法对640例胃癌患者术前行MDCT检查，其结果与手术病理结果相对照：同时．分析胃癌MDCT征象（浸润深度、淋巴结转移状况、肿瘤大小和肿瘤厚度）与腹膜转移状况的关系。结果MDCT对胃癌腹膜转移术前预测的敏感度、特异度、阳性预测值、阴性预测值和准确率分别为51．0％（25／49）、99．3％（587／591）、86．2％（25／29）、96．1％（587／611）和95．6％（612／640）。单因素分析显示。4项胃癌MDCT征象（浸润深度、淋巴结转移状况、肿瘤大小和肿瘤厚度）均与胃癌腹膜转移状况密切相关（P=0．000），MDCT判断为T0-2NxM0或TxN0M0期的胃癌病例均无腹膜转移：受试者工作特征（ROC）分析进一步显示，肿瘤大小和肿瘤厚度对预测胃癌腹膜转移状况具有较高的临床应用价值（ROC曲线下面积分别为0．83和0．75）；多因素分析显示，仅肿瘤大小与胃癌腹膜转移状况密切相关。结论MDCT对胃癌腹膜转移术前预测具有较高的准确率和临床应用价值：对MDCT判断为T0～2NxM0或TxN0M0期，或肿瘤较小的胃癌病例，由于其腹膜转移的发生概率较小而无需行腹腔镜探查。

Value of multidetector-row CT in the preoperative prediction of peritoneal metastasis from gastric cancer: a single-center and large-scale study

Objective To investigate the value of multidetector-row computed tomography (MDCT) in preoperatively predicting peritoneal metastasis of gastric cancer and to evaluate the indication for laparoscopic staging of gastric cancer on the basis of MDCT features. Methods Six hundred and forty gastric cancer patients underwent preoperative MDCT examination, and the results of MDCT were compared with surgical and pathological findings. In addition, the relationship between MDCT features (depth of invasion, lymph node metastasis status, tumor size, and thickness of tumor) and peritoneal metastasis of gastric cancer was analyzed. Results The sensitivity, specificity,positive predictive value, negative predictive value, and accuracy of MDCT in predicting peritoneal metastasis of gastric cancer were 51.0%(25/49), 99.3%(587/591), 86.2%(25/29), 96.1%(587/611),and 95.6%(612/640), respectively. Univariable analysis showed that all the four MDCT features (depth of invasion, lymph node metastasis status, tumor size, and tumor thickness) of gastric cancer were significantly correlated with the peritoneal metastasis of gastric cancer. None of the patients diagnosed with stage T_(0～2)N_xM_0 or T_xN_0M_0 gastric cancer by MDCT were found to have peritoneal metastasis.Receiver operating characteristic (ROC) analysis showed that the accuracy of the tumor size and thickness of gastric cancer in determining peritoneal metastasis was high (area under ROC curve was 0.83 and 0.75,respectively). Multivariable analysis showed that only tumor size was significantly correlated with the peritoneal metastasis from gastric cancer. Conclusions The clinical value of MDCT in preoperative prediction of peritoneal metastasis from gastric cancer is favorable. Laparoscopy can be avoided in patients with small tumor size or stage T_(0～2)N_xM_0 or T_xN_0M_0 gastric cancer diagnosed by MDCT due to lower incidence of peritoneal metastasis.