A novel nomogram can predict pathological T3a upstaged from clinical T1a in localized renal cell carcinoma

Abstract

Hypothesis: Nomogram can be built to predict the pathological T3a upstaging from clinical T1a in patients with localized renal cell carcinoma before surgery. Purpose: Renal cell carcinoma (RCC) patients with clinical T1a (cT1a) disease who are upstaged to pathological T3a (pT3a) have reduced survivals after partial nephrectomy. We aimed to develop a nomogram-based model predicting pT3a upstaging in RCC patients with preoperative cT1a based on multiple preoperative blood indexes and oncological characteristics. Materials and Methods: Between 2010 and 2019, 510 patients with cT1a RCC were individually matched according to pT3a upstaging and pathological T1a (pT1a) at a 1:4 ratio using clinicopathologic features. Least absolute shrinkage and selection operator regression analysis was used to identify the most important risk factor from 40 peripheral blood indicators, and a predictive model was established. Multivariate logistic regression analysis was performed with the screened blood parameters and clinical data to identify significant variables. Harrell's concordance index (C-index) was applied to evaluate the accuracy of the model for predicting pT3a upstaging in patients with cT1a RCC. Results: Out of 40 blood indexes, the top ranked predictor was fibrinogen (FIB). Age, the ratio of the tumor maximum and minimum diameter (ROD), FIB, and tumor size were all independent risk factors for pT3a upstaging in multivariate analysis. A predictive ARFS model (Age, ROD, FIB, tumor Size) was established, and the C-index was 0.756 (95% CI, 0.681-0.831) and 0.712 (95% CI, 0.638-0.785) in the training and validation cohorts, respectively. Conclusions: Older age, higher ROD, increased FIB level, and larger tumor size were independent risk factors for upstaging. The ARFS model has a high prediction efficiency for pT3a upstaging in patients with cT1a RCC.

Scoring system for prediction of overall survival in patients with renal cell carcinoma T3aN0M0

“…This histological pattern confers aggressiveness, poor prognosis, and a high risk of recurrence. 8,11 Our study showed similar results to the literature, 8,12,13 with the sarcomatoid pattern at higher risk of cancerspecific death (HR: 5.6) and overall mortality (HR: 5.5) than the rest of the study population.…”

Clinical safety and efficacy of microwave ablation for small renal masses

“…In addition, identification of patients at risk for pathologic upstaging could improve treatment efficacy. Utilization of models such as those previously described by Cao et al, which incorporates tumor maximum and minimum diameter, fibrinogen, and tumor size could also aid in better patient selection for ablative procedures ( 25 ).…”

Head-to-head comparisons of enhanced CT, 68Ga-PSMA-11 PET/CT and 18F-FDG PET/CT in identifying adverse pathology of clear-cell renal cell carcinoma: a prospective study

“…The pathological features of the tumor were evaluated. T1 and T2 ccRCC were defined as localized ccRCC, while T3 and T4 ccRCC were defined as locally advanced ccRCC ( 16 ). The presence of tumor necrosis ( 3 ) and sarcomatoid ( 4 ) and rhabdoid ( 5 ) features was defined as adverse pathology.…”