| Objective:To explore the value of multi-slice spiral CT(MSCT)in cT stage and cTNM stage evaluation of patients with locally advanced gastric cancer(cT4bN0-3M0)who underwent surgery after transformation therapy.Methods: The clinical data of 32 patients with gastric cancer admitted to Yantai Yuhuangding Hospital from January 2017 to April 2019 were retrospectively analyzed.Thirty-two patients were all stage IV gastric cancer patients with locally advanced gastric cancer(cT4bN0-3M0).cT4 b was a single non-resectable factor.SOX protocol was given for conversion therapy.Multi-slice spiral CT was performed before,after and 2 weeks before conversion therapy.Tumor remission was judged according to the efficacy evaluation criteria of RECIST solid tumor.Radical gastrectomy and lymph node dissection(D2)could be completed.Postoperative pathologists carefully read pathological specimens and gave pathological staging.The observed indexes include:(1)clinical T stage(cT)、N stage(cN)and clinical TNM stage(cTNM)evaluated by MSCT after conversion treatment of locally advanced gastric cancer(cT4bN0-3M0);(2)postoperative pathological determination of ypT stage、ypN stage and ypTNM stage;Postoperative pathological staging is the standard.Compared with clinical staging after conversion therapy,the accuracy,sensitivity and specificity of cT and cN staging are calculated respectively to judge the application value of MSCT clinical staging.Results:Of the 32 patients,the cancer focus of 11 patients was located in cardia,accounting for 34.4%.The cancer foci of 6 patients were located in the stomach,accounting for 18.7%.The cancer focus of 15 patients was located in pylorus,accounting for 46.9%.Postoperative pathological type: 28 patients were adenocarcinoma and 4 patients were signet ring cell carcinoma.cT staging of 32 patients: 0 cases in cT0 ～ 1 phase,4 cases in cT2 phase,21 cases in cT3 phase and 7 cases in cT4 a phase;ypT stage: 0 cases in ypT0 stage,2 cases in ypT1 stage,3 cases in ypT2 stage,20 cases in ypT3 stage and 7 cases in ypT4 a stage.There were 2 cases of cN0,9 cases of cN1,18 cases of cN2 and 3 cases of cN3.There were 8 cases of ypN0 phase,4 cases of ypN1 phase,13 cases of ypN2 phase and 7 cases of ypN3 phase.cTNM staging: 2 cases in stage Ⅰ,2 cases in stage ⅡA,0 cases in stage ⅡB,28 cases in stage Ⅲand 0 cases in stageⅣ;ypTNM stage: 5 cases in stage Ⅰ,7 cases in stage Ⅱ,20 cases in stage Ⅲ and 0 cases in stage Ⅳ.The total accuracy of cT staging after conversion therapy was 78.1%(25/32),of which the accuracy of cT2 staging was 84.4%(27/32),specificity 89.7%(26/29),sensitivity 33.34%(1/3),accuracy of cT3 staging was 84.4%(27/32),specificity 75%(9/12),sensitivity 90%(18/20),accuracy of cT4 a staging was 93.8%(30/32),specificity 96%(24/25),sensitivity 85.7%(6/7)(Table 1);The total accuracy of cN staging was 56.3%(18/32),of which the accuracy of cN0 staging was 81.3%(23/32),specificity 100%(24/24),sensitivity 25%(2/8),accuracy of cN1 staging was 71.9%(23/32),specificity 75%(21/28),sensitivity 504%(2/4).The accuracy of c N2 staging was 68.8%(22/32),specificity 63.2%(12/19),sensitivity 84.6%(11/13),accuracy of cN3 staging 87.5%(28/32),specificity 100%(25/25),sensitivity 42.9%(3/7).Total staging of cTNM: the accuracy rate of stage I was 90.6%(29/32),specificity 100%(27/27),sensitivity 40.0%(2/5),accuracy rate of stage II A was 78.1%(25/32),specificity 96.0%(24/25),sensitivity 14.3%(1/7),accuracy rate of stage III was 75.0%(24/32),specificity 33.3%(4/12),sensitivity 100%(20/20).Of the 32 patients,MSCT overestimated cT2 in 2 cases of postoperative yp T1,cT3 in 2 cases of ypT2,cT4 a in 1 case of ypT3,cT2 in 1 case of ypT3 and cT3 in 1 case of ypT4 a.MSCT overestimated cN1 in 5 cases of postoperative ypN0,cN2 in 1 case,cN2 in 2 cases of ypN1,cN1 in 2 cases of ypN2 and cN2 in 4 cases of ypN3.One case of postoperative ypTNM total stage Ⅰwas overestimated as stage ⅡA preoperatively,2 cases of postoperative ypTNM total stageⅠwas overestimated as stage Ⅲ preoperatively,6 cases of postoperative ypTNM total stage Ⅱ was overestimated as stage Ⅲ preoperatively,and there were no underestimated cases of preoperative cTNM total stage.Conclusion:MSCT examination has high accuracy in evaluating the preoperative CT staging and cTNM staging after successful transformation therapy of locally advanced gastric cancer(cT4bN0-3M0),which can provide important reference for doctors to evaluate clinical staging and select specific treatment scheme for gastric cancer patients in clinical work. |
PDF Full Text Request