ArticleAbdominal radiology (New York)2026
Pretreatment multiphasic contrast-enhanced CT predicts tumor regression grade and survival in locally advanced gastric cancer.
Article in Abdominal radiology (New York), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesReliable pretreatment prediction of pathological response remains a major challenge in locally advanced gastric cancer (LAGC). This study evaluated whether quantitative parameters from multiphasic contrast-enhanced CT (CECT) can predict tumor regression grade (TRG) after neoadjuvant chemotherapy (NAC) and provide prognostic information.
methodsWe retrospectively analyzed 116 patients with cT2-4NxM0 gastric adenocarcinoma treated with NAC treatment followed by gastrectomy between January 2019 and December 2024. Quantitative imaging variables included phase-specific tumor attenuation ([Formula: see text], normalized enhancement difference ([Formula: see text]), normalized enhancement rate ([Formula: see text]), tumor area, and enhancement pattern. TRG was assessed on surgical specimens using the Mandard system; responders were defined as TRG 1-2 and non-responders as TRG 3-5. Candidate variables were screened by univariate analysis and Spearman correlation, then enrolled into weighted multivariable logistic regression with 5-fold cross-validation. Associations with overall survival were evaluated using univariate Cox and Kaplan-Meier analyses.
resultsForty-one patients were responders and 75 were non-responders. CA199, CEA, and age were independent clinical predictors. Among imaging features, venous-phase tumor attenuation ([Formula: see text]; OR = 8.809, 95% CI: 2.134-36.358, P = 0.003) and arterial-phase normalized enhancement rate ([Formula: see text]; OR = 3.200, 95% CI: 1.365-7.504, P = 0.007) independently predicted TRG response. The clinical, imaging, and combined models achieved mean AUCs of 0.746, 0.807, and 0.869, respectively; the combined model showed the best overall discrimination (accuracy 0.759, sensitivity 0.703, specificity 0.787) with good calibration. Higher [Formula: see text] (HR = 1.01, P = 0.004) and [Formula: see text] (HR = 1.01, P = 0.043) were associated with worse overall survival.
conclusionPretreatment CECT-derived quantitative features can predict TRG response in LAGC, and a combined clinical-imaging model improves predictive performance. Higher normalized enhancement rates in the venous and delayed phases are associated with poorer overall survival, supporting pre-treatment risk stratification in clinical practice.
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