title: Impact of Combination Criteria of Nodal Counts and Sizes on Preoperative MDCT in Advanced Gastric Cancer.
abstract: BACKGROUND
  This study was designed to establish a new diagnostic criteria of preoperative nodal status with high specificity on multidetector row computed tomography (MDCT) to extract advanced gastric cancer (GC) patients with an unfavorable prognosis.
  
  
  METHODS
  From total of 480 GC patients who underwent surgical resection, 58 consecutive patients with a preoperative diagnosis of nodal metastasis on MDCT were included in this retrospective study. Nodal status on MDCT was reassessed and a prognostic analysis was performed in the present study.
  
  
  RESULTS
  Among several clinical nodal diagnostic criteria on MDCT, a cut-off value of the short-axis diameter measuring ≥15 mm showed the highest specificity (100%). The prognostic analysis revealed that patients with nodal counts on MDCT of ≥3 (p = 0.035) as well as those with a nodal diameter ≥15 mm (p < 0.001) had a significantly poor prognosis. When patients with nodal counts ≥3 and at least one node that was ≥15 mm in diameter on MDCT were defined as having extensive lymph node metastasis (ELM) that had a significantly poor prognosis (5-year survival rates of 20%, p < 0.001), and ELM was also an independent poor prognostic factor in advanced GC (p = 0.033, hazard ratio 4.038).
  
  
  CONCLUSIONS
  GC patients with nodal counts ≥3 and at least one node that was ≥15 mm in diameter on MDCT have extremely worse prognose with high diagnostic specificity. This novel surrogate indicator for preoperative imaging diagnosis may help personalized therapeutic strategies for GC patients with ELM.
authors: Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 6028566, Japan.
authors: Tsutomu
authors: T
authors: Kawaguchi
authors: Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 6028566, Japan. ichikawa@koto.kpu-m.ac.jp.
authors: Daisuke
authors: D
authors: Ichikawa
authors: Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 6028566, Japan.
authors: Shuhei
authors: S
authors: Komatsu
authors: Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 6028566, Japan.
authors: Toshiyuki
authors: T
authors: Kosuga
authors: Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 6028566, Japan.
authors: Takeshi
authors: T
authors: Kubota
authors: Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 6028566, Japan.
authors: Kazuma
authors: K
authors: Okamoto
authors: Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 6028566, Japan.
authors: Atsushi
authors: A
authors: Shiozaki
authors: Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 6028566, Japan.
authors: Hitoshi
authors: H
authors: Fujiwara
authors: Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 6028566, Japan.
authors: Hirotaka
authors: H
authors: Konishi
authors: Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 6028566, Japan.
authors: Ryo
authors: R
authors: Morimura
authors: Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 6028566, Japan.
authors: Yasutoshi
authors: Y
authors: Murayama
authors: Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 6028566, Japan.
authors: Yoshiaki
authors: Y
authors: Kuriu
authors: Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 6028566, Japan.
authors: Hisashi
authors: H
authors: Ikoma
authors: Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 6028566, Japan.
authors: Masayoshi
authors: M
authors: Nakanishi
authors: Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 6028566, Japan.
authors: Chouhei
authors: C
authors: Sakakura
authors: Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 6028566, Japan.
authors: Eigo
authors: E
authors: Otsuji
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008198:Lymph Nodes / Q000000981:diagnostic imaging*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods*; D009367:Neoplasm Staging; D011300:Preoperative Care / Q000379:methods*; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary / Q000601:surgery; D015996:Survival Rate / Q000639:trends