Can visceral fat parameters based on computed tomography be used to predict occult peritoneal metastasis in gastric cancer?

doi:10.3748/wjg.v29.i15.2310

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World Journal of Gastroenterology

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1007-9327

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World J Gastroenterol. Apr 21, 2023; 29(15): 2310-2321
Published online Apr 21, 2023. doi: 10.3748/wjg.v29.i15.2310

Table 1 Comparison of clinical and computed tomography characteristics between two groups, n (%)

Variable		PM (-) (n = 85)	PM (+) (n = 43)	P value
Sex	Male	60 (70.6)	24 (55.8)	0.096
	Female	25 (29.4)	19 (44.2)
Age (yr) (mean ± SD)		56.44±12.63	61.25±11.11	0.029¹
Pathological type	Adenocarcinoma	83 (97.6)	38 (88.4)	0.077
Pathological type	Non-adenocarcinoma	2 (2.4)	5 (11.6)
Differentiation	Poorly differentiated	50 (58.8)	30 (69.8)	0.227
	Moderately and well differentiated	35 (41.2)	13 (30.2)
CEA	Normal	74 (87.1)	37 (86.0)	0.873
	Elevated	11 (12.9)	6 (14.0)
CA199	Normal	74 (87.1)	32 (74.4)	0.073
	Elevated	11 (12.9)	11 (25.6)
CA125	Normal	83 (97.6)	37 (86.0)	0.030¹
	Elevated	2 (2.4)	6 (14.0)
Location	Cardia	44 (51.8)	7 (16.3)	0.001¹
	Body	12 (14.1)	14 (32.6)
	Antrum	20 (23.5)	13 (30.2)
	≥ 2 parts	9 (10.6)	9 (20.9)
Mild ascites	(-)	75 (88.2)	24 (55.8)	0.001¹
	(+)	10 (11.8)	29 (44.2)
cN stage	N0	26 (30.6)	11 (25.6)	0.150
	N1-2	41 (48.2)	16 (37.2)
	N3-4	18 (21.2)	16 (37.2)
cT stage	≤ T3	57 (67.1)	14 (32.6)	0.001¹
	≥ T4	28 (32.9)	29 (67.4)
Thickness (mm), median (IQR)		15.11 (13.02, 18.85)	13.43 (11.28, 17.83)	0.023¹

¹P < 0.05.

PM: Peritoneal metastasis; CEA: Carcinoembryonic antigen; CA199: Carbohydrate antigen 199; CA125: Carbohydrate antigen 199; IQR: Interquartile range.

Full Size Table

Table 2 Comparison of visceral fat characteristics between the two lesions

Variable	PM (+) (n = 43)	PM (-) (n = 85)	P value	ICC
VF_{ROI 1}
Volume (cc)	84.45 (36.70, 161.04)	87.92 (49.89, 160.75)	0.412	0.913
Mean attenuation (HU)	-82.07 ± 6.06	-85.33 ± 5.89	0.044¹	0.810
SD attenuation (HU)	18.82 (17.78, 21.25)	19.51 (18.63, 21.11)	0.133	0.926
SF_{ROI 1}
Volume (cc)	108.79 (55.10, 170.90)	115.96 (62.70, 178.72)	0.760	0.979
Mean attenuation (HU)	-85.33 ± 5.89	-86.05 ± 8.23	0.934	0.955
SD attenuation (HU)	17.94 (16.60, 19.37)	18.58 (17.27, 20.16)	0.180	0.981
VF_{ROI 2}
Volume (cc)	132.63 (58.85, 273.65)	145.48 (82.58, 277.42)	0.302	0.932
Mean attenuation (HU)	-82.19 ± 5.35	-85.70 ± 5.65	0.001¹	0.974
SD attenuation (HU)	19.86 (17.58, 20.46)	19.13 (18.47, 20.66)	0.317	0.950
SF_{ROI 2}
Volume (cc)	163.24 (82.57, 261.17)	175.86 (97.86, 267.52)	0.76	0.991
Mean attenuation (HU)	-86.28 ± 8.61	-86.41 ± 8.08	0.938	0.980
SD attenuation (HU)	17.80 (16.42, 19.33)	18.45 (17.29, 19.91)	0.124	0.993
Volume ratio
VF/SF_{ROI 1}	0.92 (0.44, 1.50)	1.00 (0.61, 1.65)	0.317	0.804
VF/SF_{ROI 2}	0.98 (0.47, 1.41)	1.00 (0.63, 1.68)	0.279	0.884

¹P < 0.05.

PM: Peritoneal metastasis; ICC: Intraclass correlation coefficient; VF: Visceral fat; SF: Subcutaneous fat; SD: Standard deviation; ROI: Region of interest; HU: Hounsfield units; ROIs 1 and 2: Regions of interest starting at the largest axial level of the tumor and extending down 15 mm and 25 mm, respectively.

Full Size Table

Table 3 Comparison of attenuations of visceral fat between different clinical characteristic classifications

Variable		Mean attenuation of VF ROI 2	P value
Sex	Male	-84.90 ± 6.19	0.306
	Female	-83.83 ± 4.88
Age (yr)	≤ 61	-84.48 ± 5.11	0.937
	> 61	-84.46 ± 5.14
Pathological type	Adenocarcinoma	-84.64 ± 5.81	0.339
	Non-adenocarcinoma	-82.49 ± 4.99
Differentiation	Poorly differentiated	-84.18 ± 5.91	0.377
	Moderately and well differentiated	-85.11 ± 5.56
CEA	Normal	-84.64 ± 5.92	0.583
	Elevated	-83.81 ± 4.86
CA199	Normal	-85.04 ± 6.04	0.002¹
	Elevated	-82.07 ± 3.40
CA125	Normal	-84.80 ± 5.81	0.039¹
	Elevated	-80.46 ± 3.41
Location	Cardia/Body/Antrum	-84.93 ± 5.86	0.049¹
	≥ 2 parts	-82.05 ± 4.67
Mild ascites	(-)	-85.41 ± 5.79	0.001¹
	(+)	-81.52 ± 4.69
cN stage	N0	-85.48 (-89.85, -82.95)	0.030¹
	N1-2	-83.08 (-86.68, -79.43)
	N3-4	-84.54 (-87.51, -80.60)
cT stage	≤ T3	-85.88 ± 5.83	0.003¹
	≥ T4	-82.84 ± 5.29
Thickness (mm)	≤ 14.5	-84.82 ± 6.36	0.517
	> 14.5	-84.15 ± 4.98

¹P < 0.05.

CEA: Carcinoembryonic antigen; CA199: Carbohydrate antigen 199; CA125: Carbohydrate antigen 199; VF: Visceral fat; ROI 2: Regions of interest starting at the largest axial level of the tumor and extending down 25 mm.

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Table 4 Stratified analysis of volume

	PM (-)	PM (+)	P value	AUC (95%CI)
Volume > median
No	45	19
Mean attenuation (HU)	-89.08 ± 5.31	-85.44 ± 3.93	0.009¹	0.726 (0.59-0.854)
Volume ≤ median
No	40	24
Mean attenuation (HU)	-81.92 ± 3.01	-79.61 ± 4.94	0.046¹	0.639 (0.490-0.787)

¹P < 0.05.

PM: Peritoneal metastasis; No: Number; AUC: Area under the curve; HU: Hounsfield units.

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Table 5 Variables and coefficients of multiple regression logistic analysis

Variable	OR	95%CI	P value
Based on all characteristics
Mild ascites (+ vs -)	3.552	(1.375-9.175)	0.009¹
Mean attenuations of VF_{ROI 2}	3.437	(0.914-12.914)	0.068
cT stage (≥ T4 vs ≤ T3)	2.631	(1.126-6.144)	0.025¹
Intercept	0.009		0.001¹
Based on clinical characteristics
Mild ascites (+ vs -)	4.188	(1.636-10.722)	0.003¹
cT stage (≥ T4 vs ≤ T3)	2.992	(1.301-6.881)	0.010¹
Intercept	0.068		0.001¹

¹P < 0.05.

VF: Visceral fat; ROI: Region of interest; OR: Odds ratio; CI: Confidence interval.

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Citation: Li LM, Feng LY, Liu CC, Huang WP, Yu Y, Cheng PY, Gao JB. Can visceral fat parameters based on computed tomography be used to predict occult peritoneal metastasis in gastric cancer? World J Gastroenterol 2023; 29(15): 2310-2321
URL: https://www.wjgnet.com/1007-9327/full/v29/i15/2310.htm
DOI: https://dx.doi.org/10.3748/wjg.v29.i15.2310