Dual-phase contrast-enhanced CT-based intratumoral and peritumoral radiomics for preoperative prediction of lymphovascular invasion in gastric cancer

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Abstract

Background

To develop and validate a dual-phase contrast-enhanced computed tomography (CT)-based intratumoral and peritumoral radiomics for the prediction of lymphovascular invasion (LVI) in patients with gastric cancer.

Method

Three hundred and eighty-three patients with gastric cancer (training cohort, 269 patients; test cohort, 114 patients) were retrospectively enrolled between January 2017 and June 2023. Radiomics features were extracted from the intratumoral volume (ITV) and peritumoral volume (PTV) on CT images at arterial phase (AP) and venous phase (VP), and selected by the least absolute shrinkage and selection operator. Radiomics models were constructed by logistic regression. The clinical-radiomics combined model incorporating the most predictive radiomics signature and clinical risk factors were developed with multivariate analysis. Receiver operating characteristic (ROC) curves were used to evaluate the prediction performance of models.

Results

Clinical model comprised of three clinical risk factors including tumor differentiation, CT-reported lymph node metastasis status and CT-TNM staging showed good performance with an area under the ROC curve (AUC) of 0.804 and 0.825 in the training and test cohort, respectively. Compared with the other radiomics models, dual-phase (AP + VP) CT-based ITV + PTV radiomics model presented superior AUC of 0.844 and 0.835 in the training and test cohort, respectively. Clinical-radiomics combined model further improved the discriminatory performance (AUC, 0.903) in the training and test cohort (AUC, 0.901). Decision curve analysis confirmed the net benefit of clinical-radiomics combined model. Subgroup analyses showed that the clinical-radiomics nomogram showed the best performance with an AUC of 0.879 and 0.883 for predicting LVI in T1-T2 and T3-T4 gastric cancer compared with the clinical model and the ITV + PTV-AP + VP radiomics model, respectively.

Conclusions

Clinical-radiomics combined model integrating clinical risk factors and dual-phase contrast-enhanced CT-based intratumoral and peritumoral radiomics signatures provided favorable performance for predicting LVI in gastric cancer.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12880-025-01569-5.

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This article provides an update on the global cancer burden using the GLOBOCAN 2020 estimates of cancer incidence and mortality produced by the International Agency for Research on Cancer. Worldwide, an estimated 19.3 million new cancer cases (18.1 million excluding nonmelanoma skin cancer) and almost 10.0 million cancer deaths (9.9 million excluding nonmelanoma skin cancer) occurred in 2020. Female breast cancer has surpassed lung cancer as the most commonly diagnosed cancer, with an estimated 2.3 million new cases (11.7%), followed by lung (11.4%), colorectal (10.0 %), prostate (7.3%), and stomach (5.6%) cancers. Lung cancer remained the leading cause of cancer death, with an estimated 1.8 million deaths (18%), followed by colorectal (9.4%), liver (8.3%), stomach (7.7%), and female breast (6.9%) cancers. Overall incidence was from 2-fold to 3-fold higher in transitioned versus transitioning countries for both sexes, whereas mortality varied <2-fold for men and little for women. Death rates for female breast and cervical cancers, however, were considerably higher in transitioning versus transitioned countries (15.0 vs 12.8 per 100,000 and 12.4 vs 5.2 per 100,000, respectively). The global cancer burden is expected to be 28.4 million cases in 2040, a 47% rise from 2020, with a larger increase in transitioning (64% to 95%) versus transitioned (32% to 56%) countries due to demographic changes, although this may be further exacerbated by increasing risk factors associated with globalization and a growing economy. Efforts to build a sustainable infrastructure for the dissemination of cancer prevention measures and provision of cancer care in transitioning countries is critical for global cancer control.

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Gastric cancer

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Gastric cancer is the fifth most common cancer and the third most common cause of cancer death globally. Risk factors for the condition include Helicobacter pylori infection, age, high salt intake, and diets low in fruit and vegetables. Gastric cancer is diagnosed histologically after endoscopic biopsy and staged using CT, endoscopic ultrasound, PET, and laparoscopy. It is a molecularly and phenotypically highly heterogeneous disease. The main treatment for early gastric cancer is endoscopic resection. Non-early operable gastric cancer is treated with surgery, which should include D2 lymphadenectomy (including lymph node stations in the perigastric mesentery and along the celiac arterial branches). Perioperative or adjuvant chemotherapy improves survival in patients with stage 1B or higher cancers. Advanced gastric cancer is treated with sequential lines of chemotherapy, starting with a platinum and fluoropyrimidine doublet in the first line; median survival is less than 1 year. Targeted therapies licensed to treat gastric cancer include trastuzumab (HER2-positive patients first line), ramucirumab (anti-angiogenic second line), and nivolumab or pembrolizumab (anti-PD-1 third line).

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Author and article information

Contributors

Hang Li: lihang111222@126.com

Journal

Journal ID (nlm-ta): BMC Med Imaging

Journal ID (iso-abbrev): BMC Med Imaging

Title: BMC Medical Imaging

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2342

Publication date (Electronic): 10 February 2025

Publication date PMC-release: 10 February 2025

Publication date Collection: 2025

Volume: 25

Electronic Location Identifier: 43

Affiliations

[1 ]Department of Radiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, ( https://ror.org/01qh26a66) 32# Second Section of First Ring Road, Qingyang District, Chengdu, Sichuan 610070 China

[2 ]Pharmaceutical Diagnostic Team, GE Healthcare, Beijing, 100176 China

Article

Publisher ID: 1569

DOI: 10.1186/s12880-025-01569-5

PMC ID: 11812222

PubMed ID: 39930340

SO-VID: 7ae2db22-5f36-4f4a-bfaf-dfe553026255

License:

Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.

History

Date received : 20 June 2024

Date accepted : 22 January 2025

Funding

Funded by: China International Medical Exchange Foundation SKY Image Research Fund Development Project

Award ID: Z-2014-07-1912

Funded by: the Key Research Project of Sichuan Province

Award ID: No.2022YFS0249

Custom metadata

ScienceOpen disciplines: Radiology & Imaging

Keywords: lymphovascular invasion,gastric cancer,ct,nomograms

Data availability: