Development and validation of an individualized nomogram to identify occult peritoneal metastasis in patients with advanced gastric cancer

Abstract

Background

Occult peritoneal metastasis (PM) in advanced gastric cancer (AGC) patients is highly possible to be missed on CT images. Patients with occult PMs are subject to late detection or even improper surgical treatment. We therefore aimed to develop a radiomic nomogram to preoperatively identify occult PMs in AGC patients.

Patients and methods

554 AGC patients from four centers were divided into one training, one internal validation, and two external validation cohorts. All patients' PM status was firstly diagnosed as negative by CT, but later confirmed by laparoscopy (PM positive n=122, PM negative n=432). Radiomic signatures reflecting phenotypes of the primary tumor (RS1) and peritoneum region (RS2) were built as predictors of PM from 266 quantitative image features. Individualized nomograms of PM status incorporating RS1, RS2, or clinical factors were developed and evaluated regarding prediction ability.

Results

RS1, RS2, and Lauren type were significant predictors of occult PM (all p<0.05). A nomogram of these three factors demonstrated better diagnostic accuracy than the model with RS1, RS2, or clinical factors alone (all net reclassification improvement p<0.05). The AUC yielded was 0.958 (95% confidence interval [CI]: 0.923-0.993), 0.941 (95% CI: 0.904-0.977), 0.928 (95% CI: 0.886-0.971), and 0.920 (95% CI: 0.862-0.978) for the training, internal, and two external validation cohorts, respectively. Stratification analysis showed that this nomogram had potential generalization ability.

Conclusion

CT phenotypes of both primary tumor and nearby peritoneum are significantly associated with occult PM status. A nomogram of these CT phenotypes and Lauren type has an excellent prediction ability of occult PM, and may have significant clinical implications on early detection of occult PM for AGC.

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