Introduction
Materials and methods
Patients
Clinicopathological diagnosis
CT imaging evaluation
Statistical analysis
Results
Clinicopathological and radiologic features
Variables | Overall (N = 776) | Non-aggressive pathology (N = 526) | Aggressive pathology (N = 250) | P |
---|---|---|---|---|
Clinical findings | ||||
Age at surgery, year (IQR) | 62.0 (53.0–69.0) | 61.0 (52.0–68.0) | 63.0 (56.0–71.0) | < 0.001 |
Gender: male (%) | 559.0 (72.0) | 377.0 (71.7) | 182.0 (72.8) | 0.744 |
Laterality: left (%) | 388.0 (50.0) | 267.0 (50.8) | 121.0 (48.4) | 0.539 |
ECOG performance status (%) | 0.005 | |||
0–1 | 752.0 (96.9) | 516.0 (98.1) | 236.0 (94.4) | |
2–4 | 24.0 (3.1) | 10.0 (1.9) | 14.0 (5.6) | |
Symptomatic presentation (%) | 246.0 (31.7) | 155.0 (29.5) | 91.0 (36.4) | 0.052 |
Hypertension (%) | 389.0 (50.1) | 263.0 (50.0) | 126.0 (50.4) | 0.917 |
Diabetes (%) | 170.0 (21.9) | 109.0 (20.7) | 61.0 (24.4) | 0.247 |
Smoking history (%) | 296.0 (38.1) | 194.0 (36.9) | 102.0 (40.8) | 0.294 |
BMI, kg/m2 (IQR) | 25.5 (23.5–27.8) | 25.6 (23.7–27.8) | 25.2 (23.1–27.6) | 0.189 |
Hemoglobin, g/L (IQR) | 138.0 (126.0-149.0) | 139.0 (128.0-151.0) | 134.0 (120.8–148.0) | < 0.001 |
NLR (IQR) | 2.3 (1.6–4.4) | 2.2 (1.6–3.5) | 2.9 (1.9–7.3) | < 0.001 |
Surgical findings | ||||
Surgical approach (%) | 0.168 | |||
Open | 17.0 (2.2) | 15.0 (2.9) | 2.0 (0.8) | |
Laparoscopic | 645.0 (83.1) | 432.0 (82.1) | 213.0 (85.2) | |
Robotic | 114.0 (14.7) | 79.0 (15.0) | 35.0 (14.0) | |
Type of nephrectomy (%) | < 0.001 | |||
Radical nephrectomy | 194.0 (25.0) | 93.0 (17.7) | 101.0 (40.4) | |
Partial nephrectomy | 582.0 (75.0) | 433.0 (82.3) | 149.0 (59.6) | |
Pathologic findings | ||||
Clinical tumor size, cm (IQR) | 4.0 (3.1–5.1) | 3.8 (2.8–4.9) | 4.5 (3.5–5.5) | < 0.001 |
CT stage (%) | 0.472 | |||
T1a | 389.0 (50.1) | 293.0 (55.7) | 96.0 (38.4) | |
T1b | 387.0 (49.9) | 233.0 (44.3) | 154.0 (61.6) | |
Histology subtype (%) | < 0.001 | |||
Clear cell RCC | 705.0 (90.9) | 490.0 (93.2) | 215.0 (86.0) | |
Papillary RCC | 33.0 (4.3) | 11.0 (2.1) | 22.0 (8.8) | |
Chromphobe RCC | 24.0 (3.1) | 19.0 (3.6) | 5.0 (2.0) | |
Others | 14.0 (1.8) | 6.0 (1.1) | 8.0 (3.2) | |
Surgical margin: positive (%) | 12.0 (1.5) | 9.0 (1.7) | 3.0 (1.2) | 0.590 |
Aggressive pathology (%) | ||||
Tumor grade: III-IV | 210.0 (27.1) | 0.0 (0.0) | 210.0 (84.0) | |
PT3a upstage | 58.0 (7.5) | 0.0 (0.0) | 58.0 (23.2) | |
type II pRCC, collecting duct, renal medullary carcinoma, unclassified RCC | 25.0 (3.2) | 0.0 (0.0) | 25.0 (10.0) | |
Sarcomatoid/rhabdoid component | 4.0 (0.5) | 0.0 (0.0) | 4.0 (1.6) |
Variables | Overall (N = 776) | Non-aggressive pathology (N = 526) | Aggressive pathology (N = 250) | P | |
---|---|---|---|---|---|
Maximal tumor diameter, cm (%) (R score) | 0.472 | ||||
≤4 | 389.0 (50.1) | 293.0 (55.7) | 96.0 (38.4) | ||
>4-<7 | 387.0 (49.9) | 233.0 (44.3) | 154.0 (61.6) | ||
Exophytic/endophytic rate (%) (E score) | 0.469 | ||||
≥50% | 386.0 (49.7) | 259.0 (49.2) | 127.0 (50.8) | ||
<50% | 254.0 (32.7) | 179.0 (34.0) | 75.0 (30.0) | ||
Endophytic | 136.0 (17.5) | 88.0 (16.7) | 48.0 (19.2) | ||
Distance to the collecting system, mm (%) (N score) | < 0.001 | ||||
>7 | 475.0 (61.2) | 351.0 (66.7) | 124.0 (49.6) | ||
4–7 | 79.0 (10.2) | 57.0 (10.8) | 22.0 (8.8) | ||
≤4 | 222.0 (28.6) | 118.0 (22.4) | 104.0 (41.6) | ||
Polar location (%) (L score) | 0.056 | ||||
Entirely above or below the polar line | 226.0 (29.1) | 164.0 (31.2) | 62.0 (24.8) | ||
Cross the polar line | 297.0 (38.3) | 204.0 (38.8) | 93.0 (37.2) | ||
>50% crosses the polar line crosses the axial renal midline or entirely between the polar lines | 253.0 (32.6) | 158.0 (30.0) | 95.0 (38.0) | ||
RENAL score (%) | 0.005 | ||||
Low (4–6) | 381.0 (49.1) | 281.0 (53.4) | 100.0 (40.0) | ||
Intermediate (7–9) | 319.0 (41.1) | 210.0 (39.9) | 109.0 (43.6) | ||
High (10–12) | 76.0 (9.8) | 35.0 (6.7) | 41.0 (16.4) | ||
CT necrosis (%) | 306(39.4) | 136(25.9) | 170(68.0) | < 0.001 | |
Calcification (%) | 46.0 (5.9) | 25.0 (4.8) | 21.0 (8.4) | 0.044 | |
Tumor margin regularity (%) | 169.0 (21.8) | 48.0 (9.1) | 121.0 (48.4) | < 0.001 | |
Peritumoral neovascularity (%) | 73.0 (9.4) | 19.0 (3.6) | 54.0 (21.6) | < 0.001 | |
Pre-contrast phase (IQR) | |||||
TAV-PCP | 30.5 (26.0–35.0) | 30.0 (26.0–35.0) | 31.0 (28.0–35.0) | 0.004 | |
HDT-PCP | 11.0 (9.0–14.0) | 11.0 (9.0–14.0) | 12.0 (9.0–14.0) | 0.03 | |
Corticomedullary phase (IQR) | |||||
TAV-CMP | 116.0 (86.0-151.8) | 119.0 (88.0-156.0) | 110.5 (84.8-148.3) | 0.062 | |
TEV-CMP | 84.0 (57.0-121.0) | 87.0 (60.0-123.3) | 78.5 (54.0-78.5) | 0.024 | |
RER-CMP | 0.7 (0.4–0.9) | 0.7 (0.5-1.0) | 0.6 (0.4–0.8) | < 0.001 | |
HDT-CMP | 40.0 (32.0–50.0) | 39.0 (32.0–50.0) | 42.0 (32.0–50.0) | 0.041 | |
Nephrographic phase (IQR) | |||||
TAV-NP | 101.0 (82.0-120.0) | 104.0 (84.0-125.0) | 97.0 (80.0-114.0) | < 0.001 | |
TEV-NP | 70.5 (52.0–90.0) | 73.0 (55.0–93.0) | 65.0 (48.0–83.0) | < 0.001 | |
RER-NP | 0.6 (0.4–0.7) | 0.6 (0.5–0.7) | 0.5 (0.4–0.6) | < 0.001 | |
HDT-NP | 27.0 (22.0–34.0) | 27.0 (22.0–34.0) | 29.0 (21.0–34.0) | 0.058 | |
Excretory phase (IQR) | |||||
TAV-EP | 81.0 (69.0–95.0) | 82.0 (69.0–96.0) | 80.0 (68.8–92.3) | 0.043 | |
TEV-EP | 50.0 (38.0–63.0) | 51.0 (39.0–65.0) | 49.0 (36.8–61.0) | 0.002 | |
RER-EP | 0.5 (0.4–0.6) | 0.5 (0.4–0.6) | 0.4 (0.3–0.5) | < 0.001 | |
HDT-EP | 20.0 (16.0–24.0) | 19.0 (16.0–24.0) | 21.0 (16.0–25.0) | 0.006 |
Determination of independent predictors
Variables | Univariate | Multivariate | ||||
---|---|---|---|---|---|---|
OR | 95%CI | P valuea | OR | 95%CI | P value | |
Clinical findings | ||||||
Age at surgery, year | 1.025 | 1.011–1.040 | < 0.001 | |||
Gender: male | 1.058 | 0.755–1.482 | 0.765 | |||
Laterality: left | 0.910 | 0.673–1.230 | 0.571 | |||
ECOG performance status: 2–4 | 3.061 | 1.340–6.992 | 0.016 | |||
Symptomatic presentation | 1.370 | 0.996–1.884 | 0.083 | |||
Hypertension | 1.016 | 0.752–1.373 | 0.917 | |||
Diabetes | 1.235 | 0.864–1.765 | 0.298 | |||
Smoking history | 1.179 | 0.867–1.605 | 0.341 | |||
BMI, kg/m2 | 0.971 | 0.929–1.015 | 0.244 | |||
Clinical tumor size, cm | 1.424 | 1.269–1.597 | < 0.001 | |||
Hemoglobin, g/L | 0.983 | 0.974–0.991 | < 0.001 | |||
NLR | 1.081 | 1.042–1.121 | < 0.001 | 1.096 | 1.050–1.145 | < 0.001 |
Surgical findings | ||||||
Surgical approach | 0.257 | |||||
Open | 1(Reference) | |||||
Laparoscopic | 3.698 | 0.838–16.318 | 0.084 | |||
Robotic | 3.323 | 0.721–15.317 | 0.124 | |||
Type of nephrectomy: Radical nephrectomy | 3.156 | 2.252–4.424 | < 0.001 | |||
Imaging findings | ||||||
Maximal tumor diameter, cm | 0.515 | |||||
≤4 | 1(Reference) | |||||
>4-<7 | 0.895 | 0.662–1.210 | ||||
Exophytic/endophytic rate | 0.529 | |||||
≥50% | 1(Reference) | |||||
<50% | 0.854 | 0.606–1.204 | 0.369 | |||
Endophytic | 1.112 | 0.738–1.678 | 0.611 | |||
Distance to the collecting system, mm | < 0.001 | 0.036 | ||||
>7 | 1(Reference) | 1(Reference) | ||||
4–7 | 1.093 | 0.641–1.861 | 0.745 | 0.548 | 0.280–1.072 | 0.079 |
≤4 | 2.495 | 1.787–3.483 | < 0.001 | 1.360 | 0.888–2.083 | 0.158 |
Polar location | 0.086 | |||||
Entirely above or below the polar line | 1(Reference) | |||||
Cross the polar line | 1.206 | 0.823–1.766 | 0.336 | |||
>50% crosses the polar line, crosses the axial renal midline or entirely between the polar lines | 1.590 | 1.080–2.343 | 0.019 | |||
CT necrosis | 6.094 | 4.382–8.474 | < 0.001 | 6.005 | 4.017–8.977 | < 0.001 |
Calcification | 1.838 | 1.008–3.351 | 0.077 | |||
Tumor margin regularity: irregular | 9.341 | 6.345–13.752 | < 0.001 | 8.037 | 5.098–12.669 | < 0.001 |
Peritumoral neovascularity | 7.352 | 4.249–12.719 | < 0.001 | 3.064 | 1.598–5.875 | 0.001 |
Pre-contrast phase | ||||||
TAV-PCP | 1.030 | 1.008–1.052 | 0.016 | |||
HDT-PCP | 1.045 | 1.004–1.087 | 0.056 | |||
Corticomedullary phase | ||||||
TAV-CMP | 0.997 | 0.994-1.000 | 0.083 | |||
TEV-CMP | 0.994 | 0.994-1.000 | 0.047 | |||
RER-CMP | 0.394 | 0.259-0.600 | < 0.001 | |||
HDT-CMP | 1.011 | 1.000-1.022 | 0.072 | |||
Nephrographic phase | ||||||
TAV-NP | 0.991 | 0.986–0.996 | 0.003 | |||
TEV-NP | 0.989 | 0.983–0.994 | < 0.001 | |||
RER-NP | 0.112 | 0.048–0.261 | < 0.001 | 0.133 | 0.047–0.374 | 0.047 |
HDT-NP | 1.004 | 0.989–1.020 | 0.084 | |||
Excretory phase | ||||||
TAV-EP | 0.993 | 0.985-1.000 | 0.080 | |||
TEV-EP | 0.989 | 0.981–0.996 | 0.010 | |||
RER-EP | 0.115 | 0.045–0.298 | < 0.001 | |||
HDT-EP | 1.032 | 1.009–1.055 | 0.015 |