Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Nov 27, 2023; 15(11): 2513-2524
Published online Nov 27, 2023. doi: 10.4240/wjgs.v15.i11.2513
Application of CD34 expression combined with three-phase dynamic contrast-enhanced computed tomography scanning in preoperative staging of gastric cancer
Hua Liu, Kang-Yan Zhao
Hua Liu, Department of Pathology, The First People's Hospital of Lianyungang, Lianyungang 222000, Jiangsu Province, China
Kang-Yan Zhao, Department of Radiology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Sciences, Xiangyang 441021, Hubei Province, China
Author contributions: Liu H designed the study and wrote the paper; Zhao KY designed the study and reviewed the manuscript; all authors annotated the manuscript.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of The First People's Hospital of Lianyungang.
Informed consent statement: This study is a retrospective study and used anonymous patients data from the past and did not pose any risks to patients, we have applied for exemption from informed consent.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kang-Yan Zhao, MM, Attending Doctor, Department of Radiology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Sciences, No. 136 Jingzhou Street, Xiangcheng District, Xiangyang 441021, Hubei Province, China. zkyhdz@163.com
Received: September 19, 2023
Peer-review started: September 19, 2023
First decision: October 8, 2023
Revised: October 26, 2023
Accepted: November 3, 2023
Article in press: November 3, 2023
Published online: November 27, 2023
Processing time: 69 Days and 1.9 Hours
Abstract
BACKGROUND

Accurate preoperative staging of gastric cancer (GC), a common malignant tumor worldwide, is critical for appropriate treatment plans and prognosis. Dynamic three-phase enhanced computed tomography (CT) scanning for preoperative staging of GC has limitations in evaluating tumor angiogenesis. CD34, a marker on vascular endothelial cell surfaces, is promising in evaluating tumor angiogenesis. We explored the value of their combination for preoperative staging of GC to improve the efficacy and prognosis of patients with GC.

AIM

To explore the evaluation value of CD34 expression + dynamic three-phase enhanced CT scanning in preoperative staging of GC.

METHODS

Medical records of 106 patients with GC treated at the First People's Hospital of Lianyungang between February 2021 and January 2023 were retrospectively studied. All patients underwent three-phase dynamic contrast-enhanced CT scanning before surgery, and CD34 was detected in gastroscopic biopsy specimens. Using surgical and pathological results as the gold standard, the diagnostic results of three-phase dynamic contrast-enhanced CT scanning at different T and N stages were analyzed, and the expression of CD34-marked microvessel density (MVD) at different T and N stages was determined. The specificity and sensitivity of three-phase dynamic contrast-enhanced CT and CD34 in T and N staging were calculated; those of the combined diagnosis of the two were evaluated in parallel. Independent factors affecting lymph node metastasis were analyzed using multiple logistic regression.

RESULTS

The accuracy of three-phase dynamic contrast-enhanced CT scanning in diagnosing stages T1, T2, T3 and T4 were 68.00%, 75.00%, 79.41%, and 73.68%, respectively, and for diagnosing stages N0, N1, N2, and N3 were 75.68%, 74.07%, 85.00%, and 77.27%, respectively. CD34-marked MVD expression increased with increasing T and N stages. Specificity and sensitivity of three-phase dynamic contrast-enhanced CT in T staging were 86.79% and 88.68%; for N staging, 89.06% and 92.86%; for CD34 in T staging, 64.15% and 88.68%; and for CD34 in N staging, 84.38% and 78.57%, respectively. Specificity and sensitivity of joint diagnosis in T staging were 55.68% and 98.72%, and N staging were 75.15% and 98.47%, respectively, with the area under the curve for diagnosis improving accordingly. According to multivariate analysis, a longer tumor diameter, higher pathological T stage, lower differentiation degree, and higher expression of CD34-marked MVD were independent risk factors for lymph node metastasis in patients with GC.

CONCLUSION

With high accuracy in preoperatively determining the invasion depth and lymph node metastasis of GC, CD34 expression and three-phase dynamic contrast-enhanced CT can provide a reliable basis for surgical resection.

Keywords: CD34; Three-phase dynamic contrast-enhanced computed tomography scanning; Gastric cancer; Preoperative staging; Invasion; Lymph node metastasis

Core Tip: We evaluated the value of CD34 expression combined with dynamic three-phase enhanced computed tomography (CT) scanning in the preoperative staging and invasion evaluation of gastric cancer (GC). This study demonstrated that the diagnostic accuracy of dynamic three-phase enhanced CT scanning for the T stage and the N stage was 68.00%-79.41% and 74.07%-85.00% respectively, and the addition of CD34-marked microvessel density improved the diagnostic efficiency. This combination can be used as a reliable basis to preoperatively assess the invasion depth and lymph node metastasis of GC and provide guidance for surgical treatment.