Abstract：
OBJECTIVE: This study examines the effectiveness of dual-energy CT (DECT) delayed-phase extracellular volume (ECV) fraction in predicting tumor regression grade (TRG) in far-advanced gastric cancer (FAGC) patients receiving preoperative immuno-chemotherapy.
METHODS: A retrospective analysis was performed on far-advanced gastric adenocarcinoma patients treated with preoperative immuno-chemotherapy at our institution from August 2019 to March 2023. Patients were categorized based on their TRG into pathological complete response (pCR) and non-pCR groups. ECV was determined using the delayed-phase iodine maps. In addition, tumor iodine densities and standardized iodine ratios were meticulously analyzed using the triple-phase enhanced iodine maps. Univariate analysis with five-fold cross-validation and Spearman correlation determined DECT parameters and clinical indicators association with pCR. The predictive accuracy of these parameters for pCR was evaluated using a weighted logistic regression model with five-fold cross-validation.
RESULTS: Of the 88 patients enrolled (mean age 60.8 ± 11.1 years, 63 males), 21 (23.9%) achieved pCR. Univariate analysis indicated ECV\'s significant role in differentiating between pCR and non-pCR groups (average p value = 0.021). In the logistic regression model, ECV independently predicted pCR with an average odds ratio of 0.911 (95% confidence interval, 0.798-0.994). The model, incorporating ECV, tumor area, and IDAV (the relative change rate of iodine density from venous phase to arterial phase), showed an average area under curves (AUCs) of 0.780 (0.770-0.791) and 0.766 (0.731-0.800) for the training and validation sets, respectively, in predicting pCR.
CONCLUSIONS: DECT-derived ECV fraction is a valuable predictor of TRG in FAGC patients undergoing preoperative immuno-chemotherapy.
CONCLUSIONS: This study demonstrates that DECT-derived extracellular volume fraction is a reliable predictor for pathological complete response in far-advanced gastric cancer patients receiving preoperative immuno-chemotherapy, offering a noninvasive tool for identifying potential treatment beneficiaries.
METHODS: A retrospective analysis was performed on far-advanced gastric adenocarcinoma patients treated with preoperative immuno-chemotherapy at our institution from August 2019 to March 2023. Patients were categorized based on their TRG into pathological complete response (pCR) and non-pCR groups. ECV was determined using the delayed-phase iodine maps. In addition, tumor iodine densities and standardized iodine ratios were meticulously analyzed using the triple-phase enhanced iodine maps. Univariate analysis with five-fold cross-validation and Spearman correlation determined DECT parameters and clinical indicators association with pCR. The predictive accuracy of these parameters for pCR was evaluated using a weighted logistic regression model with five-fold cross-validation.
RESULTS: Of the 88 patients enrolled (mean age 60.8 ± 11.1 years, 63 males), 21 (23.9%) achieved pCR. Univariate analysis indicated ECV\'s significant role in differentiating between pCR and non-pCR groups (average p value = 0.021). In the logistic regression model, ECV independently predicted pCR with an average odds ratio of 0.911 (95% confidence interval, 0.798-0.994). The model, incorporating ECV, tumor area, and IDAV (the relative change rate of iodine density from venous phase to arterial phase), showed an average area under curves (AUCs) of 0.780 (0.770-0.791) and 0.766 (0.731-0.800) for the training and validation sets, respectively, in predicting pCR.
CONCLUSIONS: DECT-derived ECV fraction is a valuable predictor of TRG in FAGC patients undergoing preoperative immuno-chemotherapy.
CONCLUSIONS: This study demonstrates that DECT-derived extracellular volume fraction is a reliable predictor for pathological complete response in far-advanced gastric cancer patients receiving preoperative immuno-chemotherapy, offering a noninvasive tool for identifying potential treatment beneficiaries.
摘要：
目的：本研究探讨了双能量CT（DECT）延迟时相细胞外体积（ECV）分数在预测接受术前免疫化疗的晚期胃癌（FAGC）患者肿瘤消退分级（TRG）中的有效性。
方法：对2019年8月至2023年3月在我院接受术前免疫化疗的晚期胃腺癌患者进行了回顾性分析。根据患者的TRG将患者分为病理完全缓解（pCR）和非pCR组。使用延迟相位碘图确定ECV。此外,使用三相增强碘图对肿瘤碘密度和标准化碘比率进行了细致分析.具有5倍交叉验证和Spearman相关性的单变量分析确定了DECT参数和临床指标与pCR的关联。使用具有5倍交叉验证的加权逻辑回归模型评估这些参数对pCR的预测准确性。
结果：在88名患者中（平均年龄60.8±11.1岁，63名男性），21（23.9%）达到pCR。单变量分析显示ECV在pCR和非pCR组之间的显著差异(平均p值=0.021)。在逻辑回归模型中，ECV独立预测pCR，平均比值比为0.911(95%置信区间，0.798-0.994）。模型,纳入ECV，肿瘤面积,和IDAV（碘密度从静脉期到动脉期的相对变化率），显示训练集和验证集的曲线下平均面积（AUC）为0.780（0.770-0.791）和0.766（0.731-0.800），分别,在预测pCR时。
结论：DECT衍生的ECV分数是接受术前免疫化疗的FAGC患者TRG的有价值的预测指标。
结论：这项研究表明，DECT衍生的细胞外体积分数是接受术前免疫化疗的晚期胃癌患者病理完全缓解的可靠预测指标，提供一种非侵入性工具来识别潜在的治疗受益者。
方法：对2019年8月至2023年3月在我院接受术前免疫化疗的晚期胃腺癌患者进行了回顾性分析。根据患者的TRG将患者分为病理完全缓解（pCR）和非pCR组。使用延迟相位碘图确定ECV。此外,使用三相增强碘图对肿瘤碘密度和标准化碘比率进行了细致分析.具有5倍交叉验证和Spearman相关性的单变量分析确定了DECT参数和临床指标与pCR的关联。使用具有5倍交叉验证的加权逻辑回归模型评估这些参数对pCR的预测准确性。
结果：在88名患者中（平均年龄60.8±11.1岁，63名男性），21（23.9%）达到pCR。单变量分析显示ECV在pCR和非pCR组之间的显著差异(平均p值=0.021)。在逻辑回归模型中，ECV独立预测pCR，平均比值比为0.911(95%置信区间，0.798-0.994）。模型,纳入ECV，肿瘤面积,和IDAV（碘密度从静脉期到动脉期的相对变化率），显示训练集和验证集的曲线下平均面积（AUC）为0.780（0.770-0.791）和0.766（0.731-0.800），分别,在预测pCR时。
结论：DECT衍生的ECV分数是接受术前免疫化疗的FAGC患者TRG的有价值的预测指标。
结论：这项研究表明，DECT衍生的细胞外体积分数是接受术前免疫化疗的晚期胃癌患者病理完全缓解的可靠预测指标，提供一种非侵入性工具来识别潜在的治疗受益者。
