Ann Surg Oncol：多排探测器CT筛选适于术前化疗的胃癌患者

　　对于可通过手术切除的胃癌患者，多排探测器CT (MDCT)能为其提供准确的术前分期结果。然而，在通过T与N分期诊断策略筛选适用于接受新辅助化疗的患者人群方面，相关常规方法及标准尚未得到确立。针对这种情况，日本神奈川癌症中心Takaki Yoshikawa博士等人进行了一项研究，该前瞻性研究的目的为，对MDCT在胃癌浆膜侵犯以及淋巴结转移方面的诊断准确性进行评价。这项研究结果发表于2012年12月25日在线出版的《外科肿瘤学年鉴》(Annals of Surgical Oncology)杂志上。

　　研究人员在研究中，按照标准化方法，对胃腺癌患者进行MDCT扫描。通过既定标准，对T与N分期进行诊断。并针对肿瘤分期为cN0-2以及M0的患者，以及以根治性胃切除术为主要治疗手段的患者进行分析。最终通过对MDCT结果以及组织病理学结果进行对比，计算得出其准确性。

　　该研究共对315例患者进行了分析。研究人员发现，T分期结果的整体诊断准确率(95 % 置信区间)为71.4 %(315例患者中的225例， 66.2-76.1)。在浆膜侵犯方面的准确率、敏感度以及特异性分别为85.7 % (81.4-89.1)、 54.5 % (42.6-66.0)以及94.0 % (90.3-96.3)。浆膜侵犯方面的假阳性率为6.0 % (2.9-7.7)。N分期结果的整体诊断准确率为75.9 % (315例患者中的239 例，70.9-80.3)。在淋巴结转移方面的准确率、敏感度以及特异性分别为81.3 % (76.6-85.2)、46.4 % (36.8-56.3)以及96.8 % (93.5-98.4)。淋巴结转移方面的假阳性率为3.2 % (1.6-6.5 %)。

　　研究人员根据得到的上述结果认为，MDCT作为一种精确的诊断方法，具有特异性高、假阳性率低的特点，可在筛选适用于接受术前化疗的患者方面进行应用。　

A Prospective Validation Study to Diagnose Serosal Invasion and Nodal Metastases of Gastric Cancer by Multidetector-row CT

Background

Multidetector-row CT (MDCT) may provide accurate preoperative staging of resectable gastric cancer. However, the standard methods and criteria to diagnose the T and N stages to select the patients who are good candidates for neoadjuvant chemotherapy have not been established yet.

Methods

The aim of this prospective study was to evaluate the accuracy of MDCT to diagnose the serosal invasion and nodal metastases of gastric cancer. Patients who had gastric adenocarcinoma underwent MDCT scanning using a standardized method. The T and N stage were diagnosed by prespecified criteria. The analyses were performed in the patients who had cN0–2 and M0 tumors and underwent curative gastrectomy as a primary treatment. The accuracy was calculated by comparing the results of MDCT with the histopathological findings.

Results

A total of 315 patients were analyzed. The overall diagnostic accuracy (95 % confidence interval) of T staging was 71.4 % (225 of 315, 66.2–76.1). The accuracy, sensitivity, and specificity for serosal invasion were 85.7 % (81.4–89.1), 54.5 % (42.6–66.0), and 94.0 % (90.3–96.3), respectively. The false-positive rate for serosal invasion was 6.0 % (2.9–7.7). The overall diagnostic accuracy of N staging was 75.9 % (239 of 315, 70.9–80.3). The accuracy, sensitivity, and specificity for nodal metastases were 81.3 % (76.6–85.2), 46.4 % (36.8–56.3), and 96.8 % (93.5–98.4), respectively. The false-positive rate for nodal metastases was 3.2 % (1.6–6.5 %).

Conclusions

These results suggest that MDCT provides an accurate diagnosis with high specificity and a low false-positive rate and can be used to select the patients who are candidates for preoperative chemotherapy.