Retrospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jun 27, 2025; 17(6): 105073
Published online Jun 27, 2025. doi: 10.4240/wjgs.v17.i6.105073
Clinical characteristics and transabdominal ultrasound features that associated with T3-T4 staging in gastric cancer: A retrospective study
Min-Ying Zhong, Guo-Liang Jian, Jie-Yi Ye, Qin-Xue Liu, Wei-Jun Huang, Chao-Jiong Zhen
Min-Ying Zhong, Guo-Liang Jian, Jie-Yi Ye, Qin-Xue Liu, Wei-Jun Huang, Chao-Jiong Zhen, Department of Ultrasound, First People's Hospital of Foshan, Foshan 528000, Guangdong Province, China
Co-first authors: Min-Ying Zhong and Guo-Liang Jian.
Co-corresponding authors: Wei-Jun Huang and Chao-Jiong Zhen.
Author contributions: Zhong MY and Jian GL have made substantial contributions to conception and design of the study, acquisition of data, or analysis and interpretation of data; Zhong MY, Ye JY, and Liu QX have drafted the article or made critical revisions related to important intellectual content of the manuscript; Huang WJ and Zhen CJ finally approved the version of the article to be published; all authors have read and approve the final manuscript. Zhong MY and Jian GL contributed equally to this work as co-first authors. Huang WJ and Zhen CJ contributed equally as co-corresponding authors. The reasons for these decisions are threefold. First, the research was performed as a collaborative effort. Listing Zhong MY and Jian GL as co-first authors accurately reflects the time and effort they invested in advancing the research and writing the paper, as well as the responsibilities and task assignments they undertook. This arrangement ensures effective communication and management of various matters during the research process, ultimately enhancing the paper's quality and reliability. Second, Huang WJ and Zhen CJ both made equally substantial contributions throughout the research. They were not only responsible for coordinating the work of the research team and ensuring effective communication and collaboration, but also provided the necessary funding and equipment for the research. This arrangement not only advanced the progress of the research but also enhanced its quality and effectiveness. They finally approved the version of the article to be published. Third, designating these researchers as co-first authors and co-corresponding authors acknowledges and respects their equal contributions, while recognizing the spirit of teamwork and collaboration in this study. In summary, we believe that designating Zhong MY and Jian GL as co-first authors and Huang WJ and Zhen CJ as co-corresponding authors is fitting for our manuscript, as it accurately reflects the collaborative spirit and equal contributions of our team.
Supported by Medical Scientific Research Foundation of Guangdong Province of China, No. A2023502; and Basic and Applied Basic Research Foundation of Guangdong Province, No. 2023A1515220135 and No. 2023A1515110607.
Institutional review board statement: The study was reviewed and approved by the First People’s Hospital of Foshan Institutional Review Board [Lun Shen Yan (2023) No.44].
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.
Data sharing statement: No additional data are available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wei-Jun Huang, PhD, Department of Ultrasound, First People's Hospital of Foshan, No. 81 Lingnan Avenue North, Chancheng District, Foshan 528000, Guangdong Province, China. hwjun1716@163.com
Received: January 14, 2025
Revised: March 24, 2025
Accepted: May 13, 2025
Published online: June 27, 2025
Processing time: 136 Days and 21.9 Hours
Abstract
BACKGROUND

Transabdominal ultrasound after the oral administration of an echoic cellulose-based gastric ultrasound contrast agent has recently been suggested to be effective in T staging of gastric cancer (GC).

AIM

To explore the clinical characteristics and transabdominal features associated with T3-T4 staging of GC.

METHODS

In total, 113 patients who underwent transabdominal ultrasonography and had confirmed GC based on surgical pathology were included. Variables including clinical characteristics [age, body mass index, gender, clinical features, pathological type, histologic type, Lauren type, carcinoembryonic antigen (CEA), and CA19-9] and transabdominal ultrasound features (thickness and length of lesion, presence of angle sign, presence of ulcer, and lesion location) were recorded. Univariate and multivariable logistic regression analyses were performed to identify the factors associated with T3-T4 staging.

RESULTS

Ninety-two patients were T3-T4 staging and 21 were T1-T2 staging. Univariate analysis revealed that the thickness of gastric lesions (1.6 ± 0.6 cm vs 1.0 ± 0.4 cm, P < 0.001), length of gastric lesions (5.7 ± 2.2 cm vs 2.9 ± 1.0 cm, P < 0.001), presence of angle sign (92.4% vs 19.0%, P < 0.001), elevated CEA (36.9% vs 0%, P < 0.001) and elevated CA19-9 (27.2% vs 14.3%, P = 0.034) were statistically significant between the two groups. Multivariable logistic regression analysis revealed that the length of gastric lesions [odds ratio (OR) = 2.373, 95% confidence interval (95%CI): 1.281-4.396, P = 0.006] and presence of angle sign (OR = 31.083, 95%CI: 4.449-217.164, P < 0.001) were independent factors associated with T3-T4 staging. A receiver operating characteristic curve was plotted, and the area under the curve was 0.950 (95% CI: 0.906-0.994, P < 0.001).

CONCLUSION

Transabdominal ultrasound features, including an angle sign and lesion length, help identify T3-T4 staging.

Keywords: Tumor staging; Angle sign; Ultrasonography; Cellulose-based ultrasound contrast agent; Stomach neoplasms

Core Tip: The accuracy of gastric cancer (GC) staging is of great significance for the choice of surgical methods and patients’ prognosis. The length of gastric lesions and presence of angle sign were independent factors associated with T3-T4 staging. The combined use can improve diagnostic accuracy. Abdominal ultrasound provides a non-invasive, cost-effective, and reproducible imaging method for T staging of GC, suggesting its potential applicability in clinical settings.