CT-based extracellular volume fraction predicts recurrence in pStage II–III gastric cancer

Overview

This retrospective study evaluated the prognostic value of preoperative CT-derived extracellular volume fraction (CT-ECV) in 112 patients with pathological stage II–III gastric cancer undergoing curative gastrectomy. Higher CT-ECV values were associated with increased risk of postoperative recurrence, suggesting CT-ECV as a potential noninvasive biomarker for risk stratification.

Background

Gastric cancer remains a leading cause of cancer-related mortality worldwide, with stage II–III patients facing high recurrence rates despite radical surgery and adjuvant chemotherapy. The tumour microenvironment, particularly the extracellular stroma, influences tumour progression and prognosis but is difficult to assess preoperatively. CT-derived extracellular volume fraction (ECV) quantifies extracellular stroma noninvasively and has shown promise as an imaging biomarker in various solid tumours. This study investigates the utility of CT-ECV in predicting recurrence risk in stage II–III gastric cancer patients.

Data Highlights

Key Findings

• Preoperative CT-ECV values correlate with the proportion of extracellular stroma in gastric cancer tissue.
• Higher CT-ECV values were significantly associated with increased risk of postoperative recurrence in pStage II–III gastric cancer patients.
• CT-ECV can be measured noninvasively using equilibrium-phase contrast-enhanced CT prior to surgery.
• CT-ECV provides prognostic information beyond conventional pathological staging and tumour markers.
• Patients with high CT-ECV may benefit from intensified postoperative surveillance or tailored adjuvant therapies.

Clinical Implications

Preoperative measurement of CT-ECV offers a practical imaging biomarker to identify stage II–III gastric cancer patients at higher risk of recurrence after curative surgery. Incorporating CT-ECV into preoperative assessment may improve treatment planning and enable personalized postoperative management strategies. This approach could optimize patient outcomes by guiding decisions on adjuvant therapy intensity and follow-up protocols.

Conclusion

CT-derived extracellular volume fraction is a promising noninvasive prognostic indicator for recurrence risk in stage II–III gastric cancer. Its integration into clinical practice may enhance risk stratification and support personalized treatment approaches.

References

1. Japanese GC Treatment Guidelines -- Gastric Cancer Treatment
2. TNM Classification of Malignant Tumours, 8th Edition -- Cancer Staging
3. Studies on CT/MR-derived ECV in solid tumours -- Imaging Biomarkers