Construction of a nomogram of overall survival of patients with clear cell renal cell carcinoma based on preoperative CT findings

doi:10.3760/cma.j.cn371439-20190923-00061

Abstract

Abstract:

Objective To explore the independent risk factors of preoperative CT findings affecting the overall survival of patients with clear cell renal cell carcinoma (ccRCC) and to draw a nomogram. Methods The retrospective study was performed on 238 patients with ccRCC who underwent preoperative CT scan and were pathologically confirmed in First Affiliated Hospital of Air Force Medical University from October 2011 to December 2015. CT findings of each patient were evaluated by two radiologists, and general information, renal function examination, and World Health Organization/International Society for Urology and Pathology (WHO/ISUP) grading were collected. The Kaplan-Meier survival curve was plotted, and survival rates were compared using log-rank test. Cox proportional hazard regression was used for univariate and multivariate analysis, and the nomogram was drawn according to the results of multivariate analysis, and the C-index was calculated after internal validation by Bootstrap 1000. Results After 3-74 months of follow-up for 238 patients, 32 cases were in the death group and 206 cases were in the censored group. The tumor diameter of the death group [(65.70±27.29) mm] was larger than that of the censored group [(46.25±26.16) mm], with a statistically significant difference (t=-3.889, P<0.001). The incidence rate of tumor necrosis (χ²=45.716, P<0.001), regional lymph node enlargement (χ²=43.342, P<0.001) and perirenal fat invasion (χ²=19.324, P<0.001) in the death group were higher than those in the censored group. Survival rates were different in patients with different tumor diameter of ccRCC, with a statistically significant difference (χ²=17.108, P<0.001). The survival rate of patients with tumor necrosis was lower than those without necrosis (χ²=48.195, P<0.001). The survival rate of patients with regional lymph node enlargement was lower than those without regional lymph node enlargement (χ²=47.232, P<0.001). The survival rate of patients with perirenal fat invasion was lower than those without perirenal fat invasion (χ²=19.964, P<0.001). Survival rates were also different in ccRCC patients with different WHO/ISUP grades, with a statistically significant difference (χ²=27.765, P<0.001). In Cox multivariate analysis, tumor diameter (HR=2.90, 95%CI: 1.37-6.14, P=0.006), necrosis (HR=8.88, 95%CI: 3.33-23.69, P<0.001) and regional lymph node enlargement (HR=4.48, 95%CI: 2.04-9.86, P<0.001) in CT findings were independent risk factors for death in patients with ccRCC. The C-index of nomogram was 0.870. Conclusion Preoperative CT findings are correlated with survival rate of patients with ccRCC, in which tumor diameter, tumor necrosis and regional lymph node enlargement are independent risk factors for death, and the nomograms has high accuracy.

Key words: Kidney neoplasms, Adenocarcinoma,clear cell, Tomography,spiral computed, Nomogram

Wang Jiali, Han Dong, Chen Ying, Zhang Yamin, Ai Meimei. Construction of a nomogram of overall survival of patients with clear cell renal cell carcinoma based on preoperative CT findings[J]. Journal of International Oncology, 2020, 47(8): 480-486.

Figures/Tables 12

References 22

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参数	截尾组 (n=206)	死亡组 (n=32)	t/χ²值	P值
年龄(岁)	52.08±12.49	54.50±14.17	-1.000	0.318
性别
女	61	9	0.029	0.864
男	145	23
肉眼血尿
无	178	27	0.001	0.972
有	28	5
胁腹部疼痛
无	153	23	0.083	0.774
有	53	9
腹部肿块
无	180	30	0.556	0.456
有	26	2
实验室检查
胱抑素C(mg/L)	1.03±0.28	1.20±0.28	-3.269	0.001
血肌酐(μmol/L)	77.32±21.45	77.41±24.86	-0.020	0.984
尿酸(μmol/L)	364.31±93.93	339.84±116.75	1.324	0.187
WHO/ISUP分级
Ⅰ级	47	2
Ⅱ级	130	15	24.806	<0.001
Ⅲ级	26	11
Ⅳ级	3	4

影像学征象	截尾组 (n=206)	死亡组 (n=32)	t/χ²值	P值
肿瘤直径(mm)	46.25±26.16	65.70±27.29	-3.889	<0.001
位置
左侧	100	13	0.696	0.404
右侧	106	19
相对密度
低密度	66	8
等密度	107	16	1.758	0.415
高密度	33	8
坏死
无	156	5	45.716	<0.001
有	50	27
钙化
无	175	25	0.962	0.327
有	31	7
区域淋巴结肿大
无	173	10	43.342	<0.001
有	33	22
肾周脂肪侵犯
无	141	9	19.324	<0.001
有	65	23

参数	HR值	95%CI	P值
年龄	1.02	0.99~1.05	0.270
性别	1.09	0.50~2.35	0.833
肉眼血尿	1.25	0.48~3.26	0.642
胁腹部疼痛	1.14	0.52~2.45	0.749
腹部肿块	0.49	0.12~2.04	0.324
胱抑素C	3.62	1.64~7.96	0.001
血肌酐	1.00	0.98~1.02	0.936
尿酸	1.00	0.99~1.00	0.211
WHO/ISUP分级
Ⅰ级	参考		<0.001
Ⅱ级	2.70	0.62~11.81	0.188
Ⅲ级	9.06	2.00~41.00	0.004
Ⅳ级	17.81	3.26~97.44	0.001
肿瘤直径(≥57.9 mm)	4.13	1.99~8.57	<0.001
位置	1.34	0.66~2.71	0.422
相对密度
低密度	参考		0.402
等密度	1.19	0.51~2.78	0.692
高密度	1.90	0.71~5.06	0.200
坏死	12.39	5.15~34.79	<0.001
钙化	1.50	0.65~3.47	0.344
区域淋巴结肿大	8.79	4.16~18.57	<0.001
肾周脂肪侵犯	4.89	2.26~10.58	<0.001

参数	HR值	95%CI	P值
肿瘤直径(≥57.9 mm)	2.90	1.37~6.14	0.006
坏死	8.88	3.33~23.69	<0.001
区域淋巴结肿大	4.48	2.04~9.86	<0.001