Clinical Scorecard: CT-based extracellular volume fraction as a prognostic indicator for recurrence after surgery in pStage II–III gastric cancer
At a Glance
Category
Detail
Condition
Pathological stage II–III gastric cancer
Key Mechanisms
Tumour stroma composition influencing tumour behaviour and prognosis; extracellular volume fraction (ECV) quantification via equilibrium-enhanced CT reflecting tumour stroma
Target Population
Patients with pStage II–III gastric adenocarcinoma undergoing curative gastrectomy
Care Setting
Preoperative imaging and postoperative follow-up in surgical oncology and radiology settings
Key Highlights
High recurrence rates persist in pStage II–III gastric cancer despite radical resection and adjuvant chemotherapy.
Tumour stroma, including extracellular matrix and associated cells, impacts tumour progression and prognosis but is difficult to assess preoperatively.
Preoperative CT-derived extracellular volume fraction (CT-ECV) may serve as a noninvasive imaging biomarker to predict postoperative recurrence risk.
Guideline-Based Recommendations
Diagnosis
Use triphasic contrast-enhanced CT including equilibrium phase to quantify extracellular volume fraction preoperatively.
Perform pathological staging according to the 8th edition of the TNM Classification after gastrectomy.
Management
Conduct R0 gastrectomy with systematic lymphadenectomy following Japanese Gastric Cancer Treatment Guidelines.
Administer postoperative adjuvant chemotherapy with S-1 or oxaliplatin-based regimens unless contraindicated.
Monitoring & Follow-up
Follow patients postoperatively with CT scans every six months for 4–60 months to detect recurrence early.
Risks
High extracellular volume fraction may indicate stroma-rich tumours associated with poorer prognosis and higher recurrence risk.
Patient & Prescribing Data
Patients with pStage II–III gastric adenocarcinoma post-curative gastrectomy
Postoperative adjuvant chemotherapy with S-1 or oxaliplatin-based combinations is standard unless contraindicated; preoperative CT-ECV may guide risk stratification.
Clinical Best Practices
Ensure high-quality triphasic contrast-enhanced CT imaging with adequate gastric distension for accurate ECV measurement.
Integrate CT-ECV assessment with conventional pathological staging to optimize preoperative risk evaluation and treatment planning.
Maintain rigorous postoperative surveillance with periodic CT imaging to enable early detection of recurrence.
