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已发表论文
术前[18F]FDG PET/CT 衍生异质性指数对临床 N0 期胃腺癌隐匿性淋巴结转移的预测价值
Authors Wu B, Tian WJ, Li L, Zhu YQ, Sun YG
Received 18 December 2024
Accepted for publication 14 August 2025
Published 17 September 2025 Volume 2025:18 Pages 5581—5589
DOI https://doi.org/10.2147/IJGM.S513034
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Ching-Hsien Chen
Bo Wu,1,* Wen-Jie Tian,2,* Lin Li,1 Yuan-Qing Zhu,1 Ying-Gang Sun1
1Department of Gastrointestinal Surgery, The 960th Hospital of the PLA Joint Logistics Support Force, Jinan, Shandong, 250000, People’s Republic of China; 2Department of Clinical Laboratory, Shanghai East Hospital South Campus, Tongji University School of Medicine, Shanghai, 200123, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Ying-Gang Sun, Email cyv173@yeah.net
Objective: To investigate the predictive value of preoperative [18F]fluorodeoxyglucose ([18F]FDG) positron emission tomography/computed tomography (PET/CT)-derived heterogeneity index (HI) for occult lymph node metastasis (OLM) in clinical N0 gastric adenocarcinoma.
Methods: This retrospective study included 83 patients with clinical N0 gastric adenocarcinoma who underwent [18F]FDG PET/CT scans before radical surgery between March 2018 and June 2024. Patients were classified as OLM-positive (n=40) or OLM-negative (n=43) based on postoperative pathology. Clinical characteristics, PET/CT metabolic parameters [maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean), peak standardized uptake value (SUVpeak), tumor-to-liver ratio (TLR), metabolic tumor volume (MTV), and total lesion glycolysis (TLG)], and heterogeneity indices (HI-1 and HI-2) were analyzed. Univariate and multivariate logistic regression models were applied to identify independent predictors of OLM. ROC curve analysis was performed to assess diagnostic performance. Statistical analysis was conducted using SPSS version 26.0, with P< 0.05 considered statistically significant.
Results: Gender, tumor differentiation, and pathological T stage differed significantly between the two groups (P< 0.05). HI-2 was significantly higher, while SUVmax, SUVmean, and HI-1 were significantly lower in the OLM-positive group (P< 0.05). Multivariate analysis identified pathological T stage (T3-T4, OR=4.778, P=0.022) and HI-2 > 4.959 (OR=6.887, P=0.002) as independent predictors of OLM. ROC analysis revealed that HI-2 had an AUC of 0.711 (95% CI: 0.596– 0.824, P=0.001), with 52.5% sensitivity and 88.37% specificity at the optimal threshold.
Conclusion: HI-2 derived from preoperative [18F]FDG PET/CT is a significant independent predictor of OLM in clinical N0 gastric adenocarcinoma patients, alongside pathological T stage.
Keywords: 18F-FDG PET/CT, heterogeneity index, gastric adenocarcinoma, occult lymph node metastasis, predictive value
1Department of Gastrointestinal Surgery, The 960th Hospital of the PLA Joint Logistics Support Force, Jinan, Shandong, 250000, People’s Republic of China; 2Department of Clinical Laboratory, Shanghai East Hospital South Campus, Tongji University School of Medicine, Shanghai, 200123, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Ying-Gang Sun, Email cyv173@yeah.net
Objective: To investigate the predictive value of preoperative [18F]fluorodeoxyglucose ([18F]FDG) positron emission tomography/computed tomography (PET/CT)-derived heterogeneity index (HI) for occult lymph node metastasis (OLM) in clinical N0 gastric adenocarcinoma.
Methods: This retrospective study included 83 patients with clinical N0 gastric adenocarcinoma who underwent [18F]FDG PET/CT scans before radical surgery between March 2018 and June 2024. Patients were classified as OLM-positive (n=40) or OLM-negative (n=43) based on postoperative pathology. Clinical characteristics, PET/CT metabolic parameters [maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean), peak standardized uptake value (SUVpeak), tumor-to-liver ratio (TLR), metabolic tumor volume (MTV), and total lesion glycolysis (TLG)], and heterogeneity indices (HI-1 and HI-2) were analyzed. Univariate and multivariate logistic regression models were applied to identify independent predictors of OLM. ROC curve analysis was performed to assess diagnostic performance. Statistical analysis was conducted using SPSS version 26.0, with P< 0.05 considered statistically significant.
Results: Gender, tumor differentiation, and pathological T stage differed significantly between the two groups (P< 0.05). HI-2 was significantly higher, while SUVmax, SUVmean, and HI-1 were significantly lower in the OLM-positive group (P< 0.05). Multivariate analysis identified pathological T stage (T3-T4, OR=4.778, P=0.022) and HI-2 > 4.959 (OR=6.887, P=0.002) as independent predictors of OLM. ROC analysis revealed that HI-2 had an AUC of 0.711 (95% CI: 0.596– 0.824, P=0.001), with 52.5% sensitivity and 88.37% specificity at the optimal threshold.
Conclusion: HI-2 derived from preoperative [18F]FDG PET/CT is a significant independent predictor of OLM in clinical N0 gastric adenocarcinoma patients, alongside pathological T stage.
Keywords: 18F-FDG PET/CT, heterogeneity index, gastric adenocarcinoma, occult lymph node metastasis, predictive value