Preoperative prediction of lymphovascular and perineural invasion in gastric cancer using spectral computed tomography imaging and machine learning

doi:10.3748/wjg.v30.i6.542

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Feb 14, 2024 (publication date) through Feb 21, 2025

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

World J Gastroenterol. Feb 14, 2024; 30(6): 542-555
Published online Feb 14, 2024. doi: 10.3748/wjg.v30.i6.542

Table 1 Comparative analysis of clinical indicators and spectral computed tomography parameters between groups

Variables	Training cohort (n = 172)			Validation cohort (n = 85)
Variables	LVI/PNI (+)	LVI/PNI (-)	P value	LVI/PNI (+)	LVI/PNI (-)	P value
Gender, n (%)
Male	77 (61.1)	49 (38.9)	0.818	47 (70.2)	20 (29.8)	0.109
Female	29 (63.0)	17 (37.0)		9 (50.0)	9 (50.0)
Age, yr, n (%)
< 60	33 (66.0)	17 (34.0)	0.450	19 (67.9)	9 (32.1)	0.788
≥ 60	73 (59.8)	49 (40.2)		37 (64.9)	20 (35.1)
CT-T
T1/2	23 (30.3)	53 (69.7)	< 0.001^a	9 (28.1)	23 (71.9)	< 0.001^a
T3/4	83 (86.5)	13 (13.5)		47 (88.7)	6 (11.3)
CT-N
N0	29 (34.9)	54 (65.1)	< 0.001^a	19 (55.8)	24 (44.2)	< 0.001^a
N1/2/3	77 (86.5)	12 (13.5)		36 (12.2)	5 (87.8)
CT-EMVI
Negative	44 (41.5)	62 (58.5)	< 0.001^a	20 (45.5)	24 (54.5)	< 0.001^a
Positive	62 (6.1)	4 (93.9)		36 (87.8)	5 (12.2)
CA72-4, n (%)
Negative	86 (57.3)	64 (42.7)	0.002^a	46 (63.9)	26 (36.1)	0.528
Positive	20 (90.9)	2 (9.1)		10 (76.9)	3 (23.1)
AFP, n (%)
Negative	104 (61.5)	65 (38.5)	1.000	54 (65.9)	28 (34.1)	1.000
Positive	2 (66.7)	1 (33.3)		2 (66.7)	1 (33.3)
CEA, n (%)
Negative	91 (61.1)	58 (38.9)	0.704	42 (61.8)	26 (38.2)	0.109
Positive	15 (65.2)	8 (34.8)		14 (82.4)	3 (17.6)
CA199, n (%)
Negative	89 (58.6)	63 (41.4)	0.022^a	48 (64.0)	27 (36.0)	0.483
Positive	17 (85.0)	3 (15.0)		8 (80.0)	2 (20.0)
CA125, n (%)
Negative	101 (60.5)	66 (39.5)	0.158	54 (65.9)	28 (34.1)	1.000
Positive	5 (100.0)	0 (0.0)		2 (66.7)	1 (33.3)
VP-70 kev, mean ± SD	92.46 ± 18.29	64.54 ± 15.90	< 0.001^a	89.87 ± 20.34	66.30 ± 18.65	< 0.001^a
EP-NIC, mean ± SD	0.68 ± 0.16	0.49 ± 0.13	< 0.001^a	0.69 ± 0.15	0.51 ± 0.12	< 0.001^a

^aP value < 0.05.

P was calculated from univariate association of characteristics with lymphovascular invasion/perineural invasion status in gastric cancer cohorts. LVI: Lymphovascular invasion; PNI: Perineural invasion; (+): Positive; (-): Negative; CT-EMVI: Computed tomography-detected extramural vein invasion; VP-70 keV: Single-energy computed tomography value of 70 keV in the venous phase; EP-NIC: Ratio of the standardized iodine concentration in the equilibrium phase; CA: Cancer antigen; CEA: Carcinoembryonic antigen; AFP: Alfa fetoprotein.

Table 2 Risk factors of lymphovascular invasion and perineural invasion in gastric cancer

Variables	Feature selection		Individual nomogram
Variables	BestFirst with probability (%)	InfoGainAttributeEval with average merit	Z value	OR (95%CI)	P value
CT-EMVI	100	0.203 ± 0.016	2.451	3.396 (1.277-9.027)	0.014
CT-T	100	0.263 ± 0.018	2.177	2.683 (1.103-6.523)	0.029
VP-70kev	90	0.356 ± 0.016	3.565	1.047 (1.021-1.074)	< 0.001
EP-NIC	90	0.239 ± 0.016	2.934	117.723 (4.867-2847.564)	0.003
CT-N	100	0.197 ± 0.014

CT-EMVI: Computed tomography-detected extramural vein invasion; VP-70 keV: Single-energy computed tomography value of 70 keV in the venous phase; EP-NIC: Ratio of the standardized iodine concentration in the equilibrium phase; OR: Odds ratio; CI: Confidence interval.

Table 3 Performance of the individual nomogram and single independent factors

	AUC (95%CI)	Sensitivity	Specificity	PPV	NPV	Accuracy
Nomogram
Training cohort	0.918 (0.866-0.954)	85.9	83.3	89.2	78.6	84.9
Validation cohort	0.874 (0.784-0.936)	87.5	75.9	87.5	75.9	83.5
CT-EMVI
Training cohort	0.762 (0.691-0.824)	58.5	93.9	93.9	58.5	72.1
Validation cohort	0.735 (0.628-0.825)	64.3	82.8	87.8	54.5	70.6
CT-T
Training cohort	0.793 (0.725-0.851)	78.3	80.3	86.5	69.7	79.1
Validation cohort	0.816 (0.717-0.892)	83.9	79.3	88.7	71.9	82.4
VP-70kev
Training cohort	0.888 (0.831-0.931)	84.9	71.2	82.6	74.6	79.7
Validation cohort	0.804 (0.703-0.882)	92.9	55.2	80.0	80.0	80.0
EP-NIC
Training cohort	0.824 (0.758-0.877)	82.1	62.1	77.7	68.3	74.4
Validation cohort	0.824 (0.726-0.898)	85.7	58.6	80.0	68.0	76.5

Citation: Ge HT, Chen JW, Wang LL, Zou TX, Zheng B, Liu YF, Xue YJ, Lin WW. Preoperative prediction of lymphovascular and perineural invasion in gastric cancer using spectral computed tomography imaging and machine learning. World J Gastroenterol 2024; 30(6): 542-555
URL: https://www.wjgnet.com/1007-9327/full/v30/i6/542.htm
DOI: https://dx.doi.org/10.3748/wjg.v30.i6.542