由于肿瘤-淋巴结-转移（TNM）系统等传统分期系统的局限性，预测胃癌（GC）患者的胃切除术后复发和死亡率仍然具有挑战性。本研究旨在调查术前亨斯菲尔德单位 (HU) 值（作为骨矿物质密度 (BMD) 替代指标）对预测 GC 患者生存结果的影响。对接受根治性胃切除术的胃癌患者的数据进行回顾性分析。使用机会性腹盆腔计算机断层扫描图像来评估第三腰椎 (L3) 的 HU 值。然后使用 110 HU 的截止值对这些值进行分类，该截止值在之前的研究中已确定为异常与正常 BMD 的决定因素。 Cox 回归分析建立了总生存期 (OS) 的预测模型。在 501 名初始患者中，478 名符合纳入标准。多变量分析显示 HU 值（风险比，1.51）以及其他因素（5 因素修正衰弱指数、胃切除术类型、TNM 分期、贫血和血清白蛋白水平）是 OS 的重要预测因子。与仅基于 TNM 分期的基线模型 (BM) 相比，包含这些变量的完整模型 (FM) 表现出卓越的辨别能力（一致性指数：0.807 vs 0.709；P < .001）。此外，FM 在预测术后 36 个月和 60 个月的 OS 风险方面优于 BM。总之，在接受胃切除治疗GC的患者中，机会性CT扫描确定的L3水平HU值 ≤ 110（表明BMD异常）的患者预后较差于HU值 > 110（表明BMD正常）的患者。将 HU 与其他临床病理学参数相结合可提高预测准确性，促进个体化风险分层和治疗决策，这可能会改善生存结果。作者版权所有 © 2024。由 Wolters Kluwer Health, Inc. 出版

Predicting postgastrectomy relapse and mortality in patients with gastric cancer (GC) remains challenging, with limitations to traditional staging systems such as the tumor-node-metastasis (TNM) system. This study aimed to investigate the impact of preoperative Hounsfield unit (HU) values, which serve as a surrogate marker for bone mineral density (BMD), in predicting survival outcomes in patients with GC. A retrospective analysis was conducted on data from patients with GC who underwent curative-intent gastrectomy. Opportunistic abdominopelvic computed tomography images were used to assess HU values at the 3rd lumbar vertebra (L3). These values were then categorized using a cutoff value of 110 HU, which has been established in previous studies as a determinant for abnormal versus normal BMD. Cox regression analysis established predictor models for overall survival (OS). Among 501 initial patients, 478 met the inclusion criteria. Multivariate analyses revealed HU values (hazard ratio, 1.51), along with other factors (the 5-factor modified frailty index, type of gastrectomy, TNM stage, anemia, and serum albumin level), as significant predictors of OS. The full model (FM) incorporating these variables demonstrated superior discrimination ability compared to the baseline model (BM), which is based solely on the TNM stage (concordance index: 0.807 vs 0.709; P < .001). Furthermore, the FM outperformed the BM in predicting OS risks at 36- and 60-months post-surgery. In conclusion, among patients undergoing gastrectomy for GC, those with HU values ≤ 110 (indicating abnormal BMD) at the L3 level, as determined through opportunistic CT scans, exhibited a poorer prognosis than those with HU values > 110 (indicating normal BMD). Integrating HU with other clinicopathological parameters enhances predictive accuracy, facilitating individualized risk stratification and treatment decision-making, which could potentially lead to improved survival outcomes.Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.