Renal cell carcinoma: A nomogram for the CT imaging-inclusive prediction of indolent,non-clear cell renal cortical tumours |
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| Affiliation: | 1. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada;2. Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy;3. Department of Urology, University Hospital Frankfurt, Frankfurt, Germany;4. Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy;5. Martini Klinik, University Medical Center Hamburg-Eppendorf, Hamburg, Germany;6. Department of Urology, European Institute of Oncology, Milan, Italy;7. Department of Urology, Medical University of Vienna, Vienna, Austria;8. Department of Urology, Second Faculty of Medicine, Charles University, Prag, Czech Republic;9. Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia;10. Division of Urology, University of Montreal Hospital Center (CHUM), Montreal, Quebec, Canada;11. Division of Urology, McMaster University, Hamilton, Ontario, Canada;1. Graduate School of Medical Technology, Teikyo University, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8605, Japan;2. Department of Radiological Technology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo 105-8470, Japan;3. Okinaka Memorial Institute for Medical Research, 2-2-2 Toranomon, Minato-ku, Tokyo 105-8470, Japan;4. Department of Radiological Technology, Southern TOHOKU General Hospital, 7-115 Yatsuyamada, Koriyama, Fukushima 963-8563, Japan;5. Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, Ishikawa 920-0942, Japan;6. Department of Radiology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8605, Japan;7. Department of Hepatology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo 105-8470, Japan |
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| Abstract: | AimTo develop a nomogram from clinical and computed tomography (CT) data for pre-treatment identification of indolent renal cortical tumours.Patients and methodsA total of 1201 consecutive patients underwent dedicated contrast-enhanced CT prior to nephrectomy for a renal cortical tumour between January 2000 and July 2011. Two radiologists evaluated all tumours on CT for size, necrosis, calcification, contour, renal vein invasion, collecting system invasion, contact with renal sinus fat, multicystic tumour architecture, nodular enhancement, and the degree of nephrographic phase enhancement. CT and clinical predictors (gender, body mass index [BMI], age) were incorporated into the nomogram. We employed multivariable logistic regression analysis to predict tumour type and internally validated the final model using the data from reader 1. External validation was performed by using all data from reader 2. We applied Wilcoxon rank sum test and Fisher’s exact test to investigate for differences in tumour size, BMI, age, and differences in CT imaging features between patients with aggressive and those with indolent tumours.Results63.6% (764/1201) of patients had clear-cell or other aggressive non-clear-cell RCC (i.e. papillary RCC type 2, unclassified RCC) and 36.4% (437/1201) had indolent renal cortical tumours (i.e. papillary RCC type 1, chromophobe RCC, angiomyolipoma, or oncocytoma). On CT, indolent tumours were significantly smaller (p < 0.001) than aggressive tumours and significantly associated with well-defined tumour contours (p < 0.001). Aggressive RCC were significantly associated with necrosis, calcification, renal vein invasion, collecting system invasion, contact with renal sinus fat, multicystic tumour architecture, and nodular enhancement (all, p < 0.001). The nomogram’s concordance index (C-index) was 0.823 after internal and 0.829 after external validation.Concluding statementWe present a nomogram based on 1201 patients combining CT features with clinical data for the prediction of indolent renal cortical tumours. When externally validated, this nomogram resulted in a C-index of 0.829. |
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| Keywords: | CT Computed Tomography Renal Cell Carcinoma RCC Clear Cell Chromophobe Papillary Oncocytoma Angiomyolipoma Nomogram |
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