Association of Abdominal Aortic Calcification with Pathological Response to Neoadjuvant Chemotherapy in Locally Advanced Gastric Cancer: A Retrospective Exploratory Study

Kutlu, Özlem; Özenbaş, Cemre; Büyüktoka, Raşit Eren; Gül, Gürkan; Tan, Feyza Arslan; Başer, Mehmet Nuri; Taşkaynatan, Halil; Özdemir, Özlem; Argon, Asuman

doi:10.31557/APJCP.2026.27.10.3723

Association of Abdominal Aortic Calcification with Pathological Response to Neoadjuvant Chemotherapy in Locally Advanced Gastric Cancer: A Retrospective Exploratory Study

Document Type : Research Articles

Authors

¹ Department of Medical Oncology, Izmir City Hospital, Izmir, Turkiye.

² Department of Radiology, Izmir Tınaztepe University, Private Buca Hospital, Izmir, Turkiye.

³ Department of Radiology, Izmir City Hospital, Izmir, Turkiye.

⁴ Department of Medical Oncology, Aydın Adnan Menderes University Hospital, Aydın, Turkiye.

⁵ Department of Pathology, Izmir City Hospital, Izmir, Turkiye.

10.31557/APJCP.2026.27.10.3723

Abstract

Background: Pathological response to neoadjuvant chemotherapy is an important prognostic determinant in patients with locally advanced gastric cancer (LAGC). However, reliable pretreatment biomarkers for predicting treatment response remain limited. Abdominal aortic calcification (AAC), an imaging marker of systemic atherosclerosis, can be readily assessed on routine computed tomography (CT). This study investigated the association between baseline AAC and pathological response to neoadjuvant chemotherapy in patients with LAGC. Methods: This retrospective exploratory study included patients with histologically confirmed LAGC who received neoadjuvant FLOT chemotherapy followed by curative-intent gastrectomy between January 2024 and January 2025. Pretreatment CT images were reviewed to quantify AAC using the abdominal aortic calcification index (ACI). Pathological response was evaluated according to the Mandard tumor regression grade (TRG) system. Receiver operating characteristic (ROC) curve analysis and logistic regression analyses were performed to evaluate the association between ACI and pathological response. Results: A total of 47 patients were included, with a median age of 64 years, and 70.2% were male. Patients with higher ACI values were significantly older than those with lower values. ROC analysis demonstrated limited discriminatory performance of ACI for predicting pathological response. Using an optimal cutoff value of 3.28, the sensitivity and specificity of ACI were 60.0% and 60.4%, respectively. Older age, hyperlipidemia, and clinical T stage were significantly associated with poorer pathological response in univariate analyses. However, ACI was not independently associated with pathological response in multivariable logistic regression analysis. Conclusions: Baseline AAC was not independently associated with pathological response to neoadjuvant chemotherapy in patients with LAGC. AAC may reflect host-related vascular aging rather than tumor-specific treatment sensitivity and may contribute to future exploratory risk-stratification models.

Keywords