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Clinical calculator based on CT and clinicopathologic characteristics predicts short-term prognosis following resection of microsatellite-stabilized diffuse gastric cancer

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Abstract

Purpose

Although microsatellite stability/Epithelial-mesenchymal transition (MSS/EMT) subtypes have been reported in multiple cancer prognosis studies, strong confounding factors between MSS/EMT (usually with Lauren’s diffuse phenotype) and diffuse gastric cancer (GC) may obscure the independent prognostic value of diffuse GC. Additionally, recent studies suggest a strong correlation between mural stratification based on CT and diffuse GC. This study aims to investigate potential prognostic factors of MSS diffuse GC using mural stratification and to develop a risk assessment model.

Methods

This retrospective study included 131 patients with MSS diffuse GC who underwent radical surgery. Univariate and multivariate Cox proportional hazards regression analysis was used to identify model predictors and construct a nomogram for overall survival (OS) and recurrence-free survival (RFS) risks. The model’s performance was evaluated using ROC, accuracy, and C-index. Internal validation of the model was conducted using the bootstrap resampling method.

Results

Among 131 cases, 60 cases (45.8%) exhibited grade 2 mural stratification, which correlated with a poorer tumor prognosis and a more invasive phenotype. Furthermore, a nomogram for predicting OS and RFS prognosis was established based on multivariate results (age, extranodal invasion, mural stratification, and/or P53). The nomogram demonstrated excellent performance, with an AUC of 0.859 (95% CI 0.794–0.924) for OS and 0.859 (95% CI 0.789–0.929) for RFS. Internal validation using 1000 bootstrap samples yielded AUC values of 0.845 and 0.846 for OS and RFS, respectively.

Conclusion

Grade 2 mural stratification based on CT imaging revealed a more aggressive invasive phenotype, characterized by increased LN metastasis, higher rates of peritoneal metastasis, and a poorer short-term prognosis. Furthermore, the CT phenotype–based nomogram demonstrates favorable discrimination and calibration, enabling convenient individual short-term prognostic evaluation following resection of MSS diffuse GC.

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Abbreviations

ACRG :

Asian Cancer Research Group

EMT :

Epithelial-mesenchymal transition

GC :

Gastric cancer

LN :

Lymph node

MSS :

Microsatellite stability

PM :

Peritoneal metastasis

SRCC :

Signet ring cell carcinoma

TCGA :

The Cancer Genome Atlas

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Funding

This research received no external funding.

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Author notes

  1. Pengpeng Liu and Ping’an Ding contributed equally to this work.

Authors and Affiliations

  1. The Third Department of Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, Hebei, China

    Pengpeng Liu, Ping’an Ding, Honghai Guo, Jiaxuan Yang, Haotian Wu, Jiaxiang Wu, Peigang Yang & Qun Zhao

  2. Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, 050011, China

    Pengpeng Liu, Ping’an Ding, Honghai Guo, Jiaxuan Yang, Haotian Wu, Jiaxiang Wu, Peigang Yang & Qun Zhao

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Contributions

Contributions: (I) Conception and design: Qun Zhao; (II) Administrative support: Qun Zhao; (III) Provision of study materials or patients: Pengpeng Liu, Ping’an Ding, Haotian Wu,Jiaxiang Wu, Peigang Yang, Yuan Tian, Honghai Guo; (IV) Collection and assembly of data: Pengpeng Liu, Ping’an Ding; (V) Data analysis and interpretation: Pengpeng Liu, Ping’an Ding; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.

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Correspondence to Qun Zhao.

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This study was approved by the Ethics Committee of the Fourth Hospital of Hebei Medical University and conducted in accordance with the ethical standards of the Helsinki Declaration. All patients signed informed consent before surgery.

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Liu, P., Ding, P., Guo, H. et al. Clinical calculator based on CT and clinicopathologic characteristics predicts short-term prognosis following resection of microsatellite-stabilized diffuse gastric cancer. Abdom Radiol (2024). https://doi.org/10.1007/s00261-024-04350-4

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  • DOI: https://doi.org/10.1007/s00261-024-04350-4

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