Association of Increased CT-Attenuation of Visceral Adipose Tissue After Surgery with Poor Survival Outcomes in Patients with Stage II-III Gastric Cancer: A Retrospective Cohort Study

Abstract

Background/objectives: This study aimed to investigate whether post-operative changes in the computed tomography (CT)-attenuation of subcutaneous (SAT) and visceral (VAT) adipose tissues were significantly associated with recurrence-free survival (RFS), peritoneal RFS, and overall survival (OS) in patients with stage II-III gastric cancer.

Methods: This retrospective study analyzed 243 patients with stage II-III gastric cancer who underwent curative surgery. CT-attenuation values of SAT (SAT HU) and VAT (VAT HU) were measured from non-contrast-enhanced abdominopelvic CT images taken pre-operatively and 6 months post-operatively. Changes in SAT HU (ΔSAT HU) and VAT HU (ΔVAT HU) between the two CT scans were calculated. The prognostic value of these variables for predicting survival outcomes was assessed.

Results: Correlation analyses showed that both ΔSAT HU and ΔVAT HU were significantly positively correlated with T stage, TNM stage, and tumor size (p < 0.05). In the multivariate survival analysis, ΔVAT HU emerged as an independent significant predictor for RFS (p = 0.002, hazard ratio, 2.437), peritoneal RFS (p = 0.023, hazard ratio, 2.457), and OS (p = 0.043, hazard ratio, 2.204) after adjusting for age, sex, histopathological classification, T stage, and N stage. Patients with high ΔVAT HU had worse RFS, peritoneal RFS, and OS compared to those with low ΔVAT HU.

Conclusions: Change in CT-attenuation of VAT following surgery was significantly correlated with tumor characteristics and was a significant predictor of RFS, peritoneal RFS, and OS in patients with stage II-III gastric cancer.