Effect of visceral adipose tissue on the accuracy of preoperative T-staging of gastric cancer

Background: Due to the anatomical characteristics of the tumor and the specific variables of the patients, the accuracy of preoperative T-staging of gastric cancer needs to be further improved. This study investigated the effect of visceral adipose tissue (VAT) on the accuracy of clinical T-staging of gastric cancer. Methods: The clinical data of 455 patients who underwent gastrectomy from January 2013 to December 2018 were analyzed retrospectively. Taking the postoperative pathological results as the reference standard, the patients were divided into accurate staging group and mistaken staging group according to the comparison of clinical T stage (cT) and pathological T stage (pT). The individual characteristics of the two groups were compared, including visceral fat content at L2/L3 level calculated on computed tomography, age, sex, tumor size, tumor location (cardia, stomach body, stomach antrum), and degree of differentiation. Multivariate logistic regression was used to determine the independent factors affecting the accuracy of cT staging. Results: Among the 455 patients, 355 patients (78.0 %) had accurate preoperative cT staging and 100 patients (22.0 %) had inaccurate preoperative cT staging. The average area of VAT in the accurate staging group was (129.8 +/- 72.6) cm(2 )and that in the mistaken staging group was (74.6 +/- 61.6) cm(2 )(P < 0.001). The optimal cut-off value of VAT was 97.8 cm(2) calculated according to the Yoden index. Multivariate logistic regression analysis showed that VAT, tumor location and tumor size were independent predictors of cT accuracy. Conclusions: Patients with lower visceral fat content (< 97.8 cm(2)) based on L2/L3 level had a higher risk of false staging in preoperative clinical T staging.