European Radiology: Relationship between imaging features of adipose tissue and postoperative complications and overall survival of gastric cancer

According to statistics, gastric cancer is the fifth most diagnosed cancer in the world and the third leading cause
of cancer death.
To date, radical gastrectomy remains the most effective treatment for
gastric cancer.
However, the complication rate after radical resection of gastric cancer is relatively high, and serious complications directly lead to patient death
.
Therefore, it is necessary
to conduct a risk assessment of patients undergoing gastric cancer surgery at an early stage and predict the risk of postoperative complications and other adverse outcomes before surgery to guide patient treatment and follow-up strategies.

Studies in recent years have shown that adipose tissue is not only an energy storage organ, but also plays a role
in metabolic and endocrine functions.
However, adipocytes can secrete various adipokines, promote angiogenesis, provide energy to tumor cells, promote tumor progression and cancer cell invasion, and cancer cells can further induce adipocytes to cause inflammatory and fibrotic changes in
adipose tissue.
Therefore, inflammation and fibrosis of adipose tissue in patients are associated
with aggressive and poor prognosis of cancer.

Computed tomography (CT) has been shown to quantitatively assess body fat, and the measurement of adipose tissue area on a single axis image of the abdomen is closely related
to the volume of adipose tissue throughout the body.
Radiation density (Hounsfield, HU) is a new imaging biomarker that is highly correlated
with the prognosis of cancer patients.
However, only a few studies have looked at the relationship between
the imaging features of adipose tissue and complications and survival in patients with gastric cancer.

Recently, a study published in the journal European Radiology evaluated the area and HU of preoperative visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) in gastric cancer patients undergoing radical gastrectomy, and explored the relationship
between these indicators and postoperative complications and overall survival (OS) in patients.

We included 122 patients, each of whom underwent laparoscopic radical gastrectomy between February 2013 and May 2016
.
The radiological characteristics of SAT and VAT were studied by preoperative computed tomography, and the relationship between
adipose tissue parameters and intraoperative and postoperative conditions and OS rates was evaluated.

In this study, it was found that VAT area was linearly positively correlated with operative time, and VAT density was linearly negatively correlated with intraoperative blood loss (both were P<0.
05).
<b20> VAT area is an independent risk factor
for postoperative complications.
VAT area and VAT density are independent risk factors
for gastric cancer OS.

 
Figure ROC curve for SAT area, SAT density, VAT area and VAT density of OS

This study showed that high VAT area was an independent risk factor for postoperative complications of gastric cancer, and VAT area and VAT density were independent risk factors
for OS in gastric cancer patients.
On this basis, a gastric cancer surgical risk assessment model can be further established to provide comprehensive indicators of nutritional status and biological factors based on the imaging characteristics of adipose tissue of patients with reference, so as to better guide clinical treatment and improve the prognosis
of gastric cancer patients.

Original source:

Linjie Bian,Danping Wu,Yigang Chen,et al.
Associations of radiological features of adipose tissues with postoperative complications and overall survival of gastric cancer patients.
DOI:10.
1007/s00330-022-08918-w