Abstract
ObjectivesTo develop and validate a radiomics nomogram to improve prediction of recurrence and metastasis risk in T1 stage clear cell renal cell carcinoma (ccRCC).MethodsThis retrospective study recruited 168 consecutive patients (mean age, 53.9 years; range, 28–76 years; 43 women) with T1 ccRCC between January 2012 and June 2019, including 50 aggressive ccRCC based on synchronous metastasis or recurrence after surgery. The patients were divided into two cohorts (training and validation) at a 7:3 ratio. Radiomics features were extracted from contrast enhanced CT images. A radiomics signature was developed based on reproducible features by means of the least absolute shrinkage and selection operator method. Demographics, laboratory variables (including sex, age, Fuhrman grade, hemoglobin, platelet, neutrophils, albumin, and calcium) and CT findings were combined to develop clinical factors model. Integrating radiomics signature and independent clinical factors, a radiomics nomogram was developed. Nomogram performance was determined by calibration, discrimination, and clinical usefulness.ResultsTen features were used to build radiomics signature, which yielded an area under the curve (AUC) of 0.86 in the training cohort and 0.85 in the validation cohort. By incorporating the sex, maximum diameter, neutrophil count, albumin count, and radiomics score, a radiomics nomogram was developed. Radiomics nomogram (AUC: training, 0.91; validation, 0.92) had higher performance than clinical factors model (AUC: training, 0.86; validation, 0.90) or radiomics signature as a means of identifying patients at high risk for recurrence and metastasis. The radiomics nomogram had higher sensitivity than clinical factors mode (McNemar’s chi-squared = 4.1667, p = 0.04) and a little lower specificity than clinical factors model (McNemar’s chi-squared = 3.2, p = 0.07). The nomogram showed good calibration. Decision curve analysis demonstrated the superiority of the nomogram compared with the clinical factors model in terms of clinical usefulness.ConclusionThe CT-based radiomics nomogram could help in predicting recurrence and metastasis risk in T1 ccRCC, which might provide assistance for clinicians in tailoring precise therapy.
Highlights
Clear cell renal cell carcinoma is the most common subtype of kidney cancer, whose incidence has been continuously increasing over the last few decades [1, 2]
Ten features were used to build radiomics signature, which yielded an area under the curve (AUC) of 0.86 in the training cohort and 0.85 in the validation cohort
Decision curve analysis demonstrated the superiority of the nomogram compared with the clinical factors model in terms of clinical usefulness
Summary
Clear cell renal cell carcinoma (ccRCC) is the most common subtype of kidney cancer, whose incidence has been continuously increasing over the last few decades [1, 2]. This trend is largely attributed to the widespread use of advantage radiologic diagnostic techniques (CT and ultrasound), as well as the popularization in regular checkups, allowing that most ccRCCs could be detected at T1 stage. Tumor-nodemetastasis stage and pathological grade are generally adopted to estimate the risk of tumor recurrence in patients with ccRCC after surgical operation.
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