Dual-phase contrast-enhanced CT-based intratumoral and peritumoral radiomics for preoperative prediction of lymph node metastasis in gastric cancer.

Objective: To determine whether intratumoral and peritumoral radiomics derived from dual-phase contrast-enhanced CT imaging could predict lymph node metastasis (LNM) in gastric cancer.

Methods: Patients with gastric cancer from January 2017 to January 2022 were retrospectively collected and were randomly divided into training cohort (n = 287) and test cohort (n = 121) with a ratio of 7: 3. Clinical features and traditional radiological features were analyzed to construct clinical model. Radiomics features based on intratumoral (ITV) and peritumoral volumetric (PTV) regions of the tumor were extracted and screened to construct radiomics models. Clinical-radiomics combined model was constructed by the most predictive radiomics features and clinical independent predictors. The correlation between LNM predicted by the best model and 2-year disease-free survival (DFS) was evaluated by the Kaplan-Meier analysis.

Results: CT-LNM and CT-T stage were independent predictors of LNM. Compared with other radiomics models, ITV + PTV on atrial and venous phase (ITV + PTV-AP + VP) radiomics model presented moderate AUCs of 0.679 and 0.670 in the training cohort and validation cohort, respectively. Among the models, clinical-radiomics combined model achieved the highest AUC of 0.894 and 0.872 in the training and test cohorts, and 0.744 and 0.784 in the T1-2 and T3-4 subgroups, respectively. Clinical-radiomics combined model based LNM could stratify patients into high-risk and low-risk groups, and 2-year DFS of high-risk group was significantly lower than that of low-risk group (p < 0.001).

Conclusions: Clinical-radiomics combined model integrating CT-LNM, CT-T stage, and ITV-PTV-AP + VP radiomics features could predict LNM, and this combined model based LNM was associated with 2-year DFS.