Abstract
ObjectiveThis study aims to develop and validate a CT-based radiomics nomogram integrated with clinic-radiological factors for preoperatively differentiating high-grade from low-grade clear cell renal cell carcinomas (CCRCCs).Methods370 patients with complete clinical, pathological, and CT image data were enrolled in this retrospective study, and were randomly divided into training and testing sets with a 7:3 ratio. Radiomics features were extracted from nephrographic phase (NP) contrast-enhanced images, and then a radiomics model was constructed by the selected radiomics features using a multivariable logistic regression combined with the most suitable feature selection algorithm determined by the comparison among least absolute shrinkage and selection operator (LASSO), recursive feature elimination (RFE) and ReliefF. A clinical model was established using clinical and radiological features. A radiomics nomogram was constructed by integrating the radiomics signature and independent clinic-radiological features. Performance of these three models was assessed using receiver operating characteristic (ROC) curve analysis and decision curve analysis (DCA).ResultsUsing multivariate logistic regression analysis, three clinic-radiological features including intratumoral necrosis (OR=3.00, 95% CI=1.30-6.90, p=0.049), intratumoral angiogenesis (OR=3.28, 95% CI=1.22-8.78, p=0.018), and perinephric metastasis (OR=2.90, 95% CI=1.03-8.17, p=0.044) were found to be independent predictors of WHO/ISUP grade in CCRCC. Incorporating the above clinic-radiological predictors and radiomics signature constructed by LASSO, a CT-based radiomics nomogram was developed, and presented better predictive performance than clinic-radiological model and radiomics signature model, with an AUC of 0.891 (95% CI=0.832-0.962) and 0.843 (95% CI=0.718-0.975) in the training and testing sets, respectively. DCA indicated that the nomogram has potential clinical usefulness.ConclusionThe CT-based radiomics nomogram is a promising tool to predict WHO/ISUP grade of CCRCC preoperatively and noninvasively.
Highlights
Renal cell carcinoma (RCC) represents the most common malignant neoplasm of the kidney in adults, of which 70–80% are categorized as clear cell renal cell carcinoma (CCRCC) [1, 2]
Univariate analysis showed that tumor size, intratumoral necrosis, intratumoral calcification, invasion of the renal capsule, intratumoral angiogenesis, venous invasion, and perinephric metastasis served as the risk factors of WHO/ISUP grade in CCRCC
We developed and validated a radiomics nomogram for noninvasive, and individualized prediction of WHO/ISUP nuclear grade of CCRCC
Summary
Renal cell carcinoma (RCC) represents the most common malignant neoplasm of the kidney in adults, of which 70–80% are categorized as clear cell renal cell carcinoma (CCRCC) [1, 2]. The prognosis of patients with CCRCC is closely related to the tumor nuclear grade [7]. As the most generally adopted grading system, the World Health Organization/International Society of Urological Pathology (WHO/ISUP) classification system categorizes tumors of nuclear grade I and II as low-grade and of grade III and IV as high- grade. High-grade CCRCC differs from low-grade CCRCC in malignant biological behaviors that generate mortal clinical outcomes [8]. Percutaneous biopsy has been criticized for the risks of procedural complications, potential sampling errors, and mismatch with pathology outcomes, it is the only preoperative method for identifying the confirmed grade of CCRCC [9]. A noninvasive, efficient method for identifying the pathological grade of CCRCC is urgently needed
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