Tumor volume: a new prognostic factor of oncological outcome of localized clear cell renal cell carcinoma

Xiao-Dong Li,Peng Huang,Zhi-Bin Ke,Xue-Yi Xue,Long-Yao Xu,Yu-Peng Wu,Ning Xu,Yong Wei,Fei Lin,Shao-Hao Chen,Qing-Shui Zheng

doi:10.1186/s12885-021-07795-8

Abstract

BackgroundClear cell renal cell carcinoma (ccRCC) is one of the most frequent malignancies; however, the present prognostic factors was deficient. This study aims to explore whether there is a relationship between tumor volume (TV) and oncological outcomes for localized ccRCC.MethodsSeven hundred forty-nine localized ccRCC patients underwent surgery in our hospital. TV was outlined and calculated using a three-dimensional conformal radiotherapy planning system. We used receiver operating characteristic (ROC) curves to identified optimal cut-off value. Univariable and multivariable Cox regression models were performed to explore the association between TV and oncological outcomes. Kaplan-Meier method and log-rank test were used to estimate survival probabilities and determine the significance, respectively. Time-dependent ROC curve was utilized to assess the prognostic effect.ResultsLog rank test showed that higher Fuhrman grade, advanced pT classification and higher TV were associated with shortened OS, cancer-specific survival (CSS), freedom from metastasis (FFM) and freedom from local recurrence (FFLR). multivariable analysis showed higher Fuhrman grade and higher TV were predictors of adverse OS and CSS. The AUC of TV for FFLR was 0.822. The AUC of TV (0.864) for FFM was higher than that of pT classification (0.818) and Fuhrman grade (0.803). For OS and CSS, the AUC of TV was higher than that of Fuhrman grade (0.832 vs. 0.799; 0.829 vs 0.790).ConclusionsHigh TV was an independent predictor of poor CSS, OS, FFLR and FFM of localized ccRCC. Compared with pT classification and Fuhrman grade, TV could be a new and better prognostic factor of oncological outcome of localized ccRCC, which might contribute to tailored follow-up or management strategies.

Highlights

Clear cell renal cell carcinoma is one of the most frequent malignancies; the present prognostic factors was deficient
High tumor volume (TV) was an independent predictor of poor cancer-specific survival (CSS), overall survival (OS), freedom from local recurrence (FFLR) and freedom from metastasis (FFM) of localized Clear cell renal cell carcinoma (ccRCC)
T staging is based on the maximum diameter of solid tumors such as renal cell carcinoma (RCC) [9] and hepatocellular carcinoma [10]; tumor diameter could not be fully representative of tumor volume (TV)

Summary

Introduction

Clear cell renal cell carcinoma (ccRCC) is one of the most frequent malignancies; the present prognostic factors was deficient. This study aims to explore whether there is a relationship between tumor volume (TV) and oncological outcomes for localized ccRCC. As one of the most frequent malignancies, renal cell carcinoma (RCC) accounted for approximately 2–3% of all cancers [1, 2]. Other well-known prognostic parameters included tumor necrosis [11], warm ischemia time, multifocality [12], bilateral occurrence of carcinoma [13], sarcomatoid and rhabdoid features [14], vascular and lymphatic microfiltration [15], caval or renal thrombosis [16]; they were deficient. There is accumulating evidence that the measurement of TV is applied to the evaluation of renal function [17,18,19,20], but only a few report on the relationship between oncological outcomes and TV of ccRCC [21]

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