Multiscale Spatial Fusion Feature-Driven Characterization of Gastric Cancer Invasive Margins: A Multicenter Cohort Study for Preoperative Accurate Differentiation Between T4a and T4b Subtypes.
Authors
Affiliations (13)
Affiliations (13)
- Department of Gastric Surgery, Cancer Hospital of Dalian University of Technology, Liaoning Cancer Hospital & Institute, Shenyang, Liaoning, China.
- School of Pharmacy, China Medical University, Shenyang, Liaoning, China.
- Department of Gastric Surgery, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Digestive Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin Clinical Research Center for Cancer, Tianjin, China.
- Shenyang Mental Health Center, Shenyang, Liaoning, China.
- Department of Radiology, Hunnan Central Hospital, Shenyang, Liaoning, China.
- Department of Medical Oncology, The First Hospital of China Medical University, Shenyang, Liaoning, China.
- School of Management, Hebei University, Baoding, Hebei, China.
- Department of Pathology, Cancer Hospital of Dalian University of Technology, Liaoning Cancer Hospital & Institute, Shenyang, Liaoning, China.
- Department of Radiotherapy, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Cancer Hospital of Dalian University of Technology, Shenyang, Liaoning, China.
- Center of Translational Medicine and Department of Gastroenterology, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning, China.
- Department of Laboratory Medicine, Institute of Laboratory Medicine, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China.
- Department of Nuclear Medicine, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China.
- Department of Thoracic Surgery, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi Medical Center, Nanjing Medical University, Wuxi, Jiangsu, China.
Abstract
Accurate preoperative differentiation of gastric cancer T4a/b stages is crucial for surgical planning and prognosis. However, conventional CT assessments often yield suboptimal staging accuracy due to visual limitations and inadequate peritumoral microinvasion quantification. This study developed a multi-scale spatial feature fusion model based on extended regions of interest (eROI) for precise preoperative T4a/b differentiation. We proposed the GAVR model with a three-tier architecture: a Boundary-Augmented U-Net for eROI generation incorporating the peritumoral microenvironment; parallel pathways extracting conventional radiomics, 2D, and 3D deep learning features; and a Vision Transformer for global attention-weighted fusion and discriminative representation learning. The model was validated across a multicenter cohort of 1804 patients, including internal, external, and prospective sets. A blinded reader study involving 16 radiologists evaluated its clinical utility. GAVR demonstrated exceptional generalizability, achieving AUCs of 0.987 and 0.979 in two independent external sets and 0.987 prospectively. Ablation studies confirmed the necessity of multi-scale features. GAVR assistance significantly improved radiologists' diagnostic accuracy (0.609 to 0.795) and reduced reading time by 60%. By deeply fusing multi-scale spatial features, GAVR characterizes structural heterogeneity in complex gastric cancer invasive margins and mitigates overfitting. It demonstrates clear translational value as an embeddable decision-support tool for multidisciplinary gastric cancer management.