基于CT脂肪分布的胃癌营养风险分级再解读BMI
本研究回顾性纳入5个中心643例接受新辅助化疗后根治性胃切除的局部进展期胃癌患者，利用CT测量内脏/皮下脂肪比变化（ΔVSR）联合基线BMI建立性别特异性营养风险评分（NRSS）。NRSS联合ypN分期形成NRSS-ypN分级（I–IV级），评估其预后分层能力并与AJCC第8版ypTNM分期比较。结果显示NRSS-ypN分级对总生存的区分度优于ypTNM分期（C指数0.715 vs 0.693，P<0.05）。
要点
- CT测量ΔVSR结合基线BMI可用于局部进展期胃癌新辅助治疗后营养代谢风险分层
- NRSS-ypN IV级患者预后差，中位总生存和无病生存均为16个月
- 报告胃癌新辅助后CT时可关注内脏与皮下脂肪比例变化，辅助预后判断
核心结论
- NRSS-ypN分级整合营养代谢状态与肿瘤负荷，可改善新辅助治疗后行R0切除局部进展期胃癌患者的术后风险分层
研究设计与样本
- 回顾性多中心研究，纳入5个中心连续643例接受新辅助化疗后根治性胃切除的局部进展期胃癌患者
- 利用CT测量内脏/皮下脂肪比变化（ΔVSR）联合基线BMI建立性别特异性营养风险评分（NRSS）
- 参考标准为AJCC第8版ypTNM分期，比较指标包括总生存与无病生存及C指数
关键影像表现/征象
- CT可测量内脏脂肪与皮下脂肪面积，计算两者比例并评估治疗前后变化（ΔVSR）
诊断标准与关键数值
- NRSS分期越高，总生存与无病生存越差（log-rank P<0.05）
- 多变量分析显示NRSS与ypN分期均为总生存和无病生存的独立预后因素
- NRSS-ypN I–IV级3年总生存率分别为87.9%、77.9%、58.9%、29.5%（log-rank P<0.0001）
- NRSS-ypN IV级患者中位总生存和无病生存均为16个月
- 总生存C指数NRSS-ypN为0.715，AJCC第8版ypTNM为0.693（P<0.05），无病生存结果相似
临床应用与阅片要点
- 阅片时可结合新辅助治疗前后CT脂肪测量辅助评估胃癌患者营养代谢变化
- NRSS-ypN分级可用于术后风险再分层，识别预后极差的IV级患者
局限性
- 回顾性研究设计
- 多中心数据但未说明中心间测量一致性控制细节
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
英文原文（摘要）· 点击展开
RATIONALE AND OBJECTIVES: Nutritional and metabolic status may influence prognosis in locally advanced gastric cancer (LAGC), yet current AJCC staging systems mainly reflect tumor burden and do not account for treatment-related nutritional changes during neoadjuvant chemotherapy (NACT).
MATERIALS AND METHODS: A total of 643 consecutive patients with LAGC undergoing NACT followed by curative gastrectomy across five centers were retrospectively analyzed. Changes in the visceral-to-subcutaneous adipose ratio (ΔVSR) combined with baseline body mass index were used to establish a sex-specific Nutritional Risk Score Scale (NRSS). A disease-weighted classification integrating NRSS and ypN stage (NRSS-ypN, Grades I-IV) was further developed. Prognostic performance was compared with AJCC 8th ypTNM staging.
RESULTS: Increasing NRSS stage was associated with significantly worse overall survival (OS) and disease-free survival (DFS) (both log-rank P < 0.05). Multivariable analyses identified both NRSS and ypN stage as independent prognostic factors for OS and DFS. The integrated NRSS-ypN classification demonstrated clear prognostic stratification, with 3-year OS rates of 87.9%, 77.9%, 58.9%, and 29.5% across Grades I-IV (log-rank P < 0.0001). Grade IV patients showed particularly poor outcomes, with median OS and DFS of 16 months. Compared with AJCC 8th ypTNM staging, the NRSS-ypN classification showed improved prognostic discrimination for OS (C-index: 0.715 vs. 0.693, P < 0.05), with similar findings for DFS.
CONCLUSION: The NRSS-ypN classification integrates nutritional-metabolic status with tumor burden and may improve postoperative risk stratification in patients with locally advanced gastric cancer undergoing neoadjuvant therapy followed by curative (R0) resection.
引用
- Zheng, Zhang, Chen, et al. CT-based Fat Distribution-Informed Reinterpretation of BMI for Disease-Weighted Nutritional Risk Classification in Gastric Cancer-Insights from Multicenter Data. Acad Radiol. 2026. PMID: 42236340. doi:10.1016/j.acra.2026.05.012
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。