A computed tomography-based preoperative risk scoring system to distinguish lymphoepithelioma-like gastric carcinoma from non-lymphoepithelioma-like gastric carcinoma

Abstract

PurposeThe aim of this study was to develop a preoperative risk scoring model for distinguishing lymphoepithelioma-like gastric carcinoma (LELGC) from non-LELGC based on contrast-enhanced computed tomography (CT) images.MethodsClinicopathological features and CT findings of patients with LELGC and non-LELGC in our hospital from January 2016 to July 2022 were retrospectively analyzed and compared. A preoperative risk stratification model and a risk scoring system were developed using logistic regression.ResultsTwenty patients with LELGC and 40 patients with non-LELGC were included in the training cohort. Significant differences were observed in Epstein–Barr virus (EBV) infection and vascular invasion between the two groups (p < 0.05). Significant differences were observed in the distribution of location, enhancement pattern, homogeneous enhancement, CT-defined lymph node status, and attenuations in the non-contrast, arterial, and venous phases (all p < 0.05). Enhancement pattern, CT-defined lymph node status, and attenuation in venous phase were independent predictors of LELGC. The optimal cutoff score of distinguishing LELGC from non-LELGC was 3.5. The area under the receiver operating characteristic curve, sensitivity, specificity, and accuracy of risk identification model in the training cohort were 0.904, 87.5%, 80.0%, and 85.0%, respectively. The area under the receiver operating characteristic curve, sensitivity, specificity, and accuracy of risk identification model in the validation cohort were 0.705 (95% CI 0.434–0.957), 75.0%, 63.6%, and 66.7%, respectively.ConclusionA preoperative risk identification model based on CT imaging data could be helpful for distinguishing LELGC from non-LELGC.

Perspectives for immunotherapy ofEBV‐associatedGLELC: A relatively “hot” tumor microenvironment

“…34 GLELC has special pathological characteristics, including stromal and intense lymphocytic infiltration. 35 In addition to being associated with EBV infection, another pathological type of GLELC is microsatellite instability (MSI)-high tumors. 36 Min et al revealed that EBV infection could serve as an independent predictor of survival in patients with LELC.…”

“…Lymphoepithelioma‐like gastric carcinoma is a rare type of EBVaGC that was first reported in 1976 34 . GLELC has special pathological characteristics, including stromal and intense lymphocytic infiltration 35 . In addition to being associated with EBV infection, another pathological type of GLELC is microsatellite instability (MSI)‐high tumors 36 .…”