A quantified risk-scoring system including the visceral fat area for peritoneal metastasis of gastric cancer
Received 13 November 2018
Accepted for publication 26 February 2019
Published 10 April 2019 Volume 2019:11 Pages 2903—2913
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Andrew Yee
Peer reviewer comments 3
Editor who approved publication: Dr Chien-Feng Li
Xiaodong Chen,1,* Weisheng Chen,2,* Yunshi Huang,2 Jingxuan Xu,1 Yunpeng Zeng,1 Mingming Shi,2 Libin Xu,2 Weiteng Zhang,2 Guanbao Zhu,2 Chenchen Mao,1 Xian Shen1,2
1Department of Gastrointestinal Surgery, The Second Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, People’s Republic of China; 2Department of Gastrointestinal Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, People’s Republic of China
*These authors contributed equally to this work
Background: Peritoneal metastases of gastric cancer are usually detected using imaging, However, the results of imaging modalities are not always reliable; therefore, the prediction of prognosis based on these findings is therefore inaccurate. As visceral obesity has been identified as a potential risk factor for cancer, the present study aimed to evaluate the predictive value of visceral fat area (VFA), a representative marker of visceral obesity, for peritoneal metastasis in patients with gastric cancer and to construct a reliable preoperative prediction system for peritoneal metastasis.
Patients and methods: We enrolled 859 patients with gastric cancer. The VFA and other objective clinical tumor characteristics were evaluated using receiver operating characteristic (ROC) curves. Independent predictors of peritoneal metastasis were determined using logistic regression analysis; a prediction system was also evaluated using ROC curves.
Results: The ROC curves indicated a VFA cutoff value of 91.00 cm2 as predictive of peritoneal metastasis. On logistic regression, visceral obesity (VFA ≥91.00 cm2) was identified as an independent predictor of peritoneal metastasis, with an area under the ROC curve of 0.659; the platelet-to-lymphocyte ratio (PLR), invasion depth, and vascular invasion were also identified as independent predictors. On integrating these predictors into a single prediction system, peritoneal metastases were more reliably predicted (area under the ROC curve=0.779).
Conclusions: Visceral obesity, as defined by the VFA, effectively predicted peritoneal metastases in our cohort. Our scoring system may be a reliable instrument for identifying patients with peritoneal metastasis.
Keywords: gastric cancer, peritoneal metastasis, visceral fat area, risk-scoring system
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