Abstract
This study was aimed at building a computed tomography- (CT-) based radiomics approach for the differentiation of sarcomatoid renal cell carcinoma (SRCC) and clear cell renal cell carcinoma (CCRCC). It involved 29 SRCC and 99 CCRCC patient cases, and to each case, 1029 features were collected from each of the corticomedullary phase (CMP) and nephrographic phase (NP) image. Then, features were selected by using the least absolute shrinkage and selection operator regression method and the selected features of the two phases were explored to build three radiomics approaches for SRCC and CCRCC classification. Meanwhile, subjective CT findings were filtered by univariate analysis to construct a radiomics model and further selected by Akaike information criterion for integrating with the selected image features to build the fifth model. Finally, the radiomics models utilized the multivariate logistic regression method for classification and the performance was assessed with receiver operating characteristic curve (ROC) and DeLong test. The radiomics models based on the CMP, the NP, the CMP and NP, the subjective findings, and the combined features achieved the AUC (area under the curve) value of 0.772, 0.938, 0.966, 0.792, and 0.974, respectively. Significant difference was found in AUC values between each of the CMP radiomics model (0.0001 ≤ p ≤ 0.0051) and the subjective findings model (0.0006 ≤ p ≤ 0.0079) and each of the NP radiomics model, the CMP and NP radiomics model, and the combined model. Sarcomatoid change is a common pathway of dedifferentiation likely occurring in all subtypes of renal cell carcinoma, and the CT-based radiomics approaches in this study show the potential for SRCC from CCRCC differentiation.
Highlights
Sarcomatoid renal cell carcinoma (SRCC) is a special subtype of renal cell carcinoma (RCC)
Sarcomatoid change is believed to be a common pathway of dedifferentiation likely occurring in all subtypes of RCC tumors [4], and preoperative identification of the change is challenging but important in clinic
This study found that the computed tomography- (CT-)based radiomics approach could help discriminate the SRCC and clear cell renal cell carcinoma (CCRCC) tumors and it achieved superior performance over the subjective CT findings
Summary
Sarcomatoid renal cell carcinoma (SRCC) is a special subtype of renal cell carcinoma (RCC). SRCC is uncommon but highly aggressive, accounting for approximately 1/6 cases of advanced kidney cancers. It results in more dismal prognosis than the common subtype of clear cell renal cell carcinoma (CCRCC) [2]. According to the newly International Society of Urological Pathology (ISUP) grading system, RCC will be classified to grade IV when a sarcomatoid component was identified [3, 4]. Most systemic therapies developed for metastatic RCC are less effective in SRCC [8]. Ablative technique is an option for small renal masses, there is no BioMed Research International
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