R.E.N.A.L. Nephrometry Score: A Preoperative Risk Factor Predicting the Fuhrman Grade of Clear-Cell Renal Carcinoma

Abstract

Objective: The purpose of this study was to evaluate the efficacy and feasibility of the R.E.N.A.L. Nephrometry Score to postoperatively predict high-grade clear-cell renal carcinoma (ccRCC).Methods: The study included 288 patients diagnosed with ccRCC who had complete CT/CTA data and R.E.N.A.L. Nephrometry Scores and underwent renal surgery at our center between January 2012 and December 2015. The relationship between the pathological grade of renal masses and R.E.N.A.L. Nephrometry Score was evaluated.Results: Univariate analysis indicated that diagnostic modality, cystic necrosis, enlargement of the regional lymph node, distant metastasis, clinical T stage, TNM stage, surgical modality, tumor size, nearness of the tumor to the collecting system or sinus, total Nephrometry Score and individual anatomic descriptor components were significantly associated with postoperative tumor grade (P < 0.05). Multivariate analysis showed that tumor size, the maximal diameter (R score), exophytic/endophytic properties (E score) and the location relative to the polar lines (L score) were independent prognostic factors to preoperatively predicting ccRCC pathological grade. The areas under the ROC curve with respect to the multi-parameter regression model (0.935, 95%CI: 0.904-0.966), tumor size (0.901, 95%CI: 0.866-0.937), R score (0.868, 95%CI: 0.825-0.911), E score (0.511, 95%CI: 0.442-0.581) and L score (0.842, 95%CI: 0.791-0.892) were calculated and compared.Conclusion: Tumor size, as well as R, E, and L scores were independent prognostic factors for high-grade pathology. Lager tumor sizes and higher R, E and L scores were more likely to be associated with high-grade pathological outcomes. Thus, the R.E.N.A.L. Score is of practical significance in facilitating urologists to make therapeutic decisions.

<p>New Preoperative Nomogram Using the Centrality Index to Predict High Nuclear Grade Clear Cell Renal Carcinoma</p>

“…23,24 Because there are many thin-walled veins and lymphatic vessels in the renal sinus, if the tumor invades the renal sinus and veins, the sufficient blood oxygen supply will promote further tumor growth, which promotes invasiveness. 25 This may be one mechanism underlying the development of low CI in kidney cancer associated with high WHO/ISUP grading.…”

“…26 Frank et al reported that 90.8% of renal tumors smaller than 2 cm had a low grade, 27 and Chen et al's multiple regression analysis also suggested that larger tumor size predicted ccRCC pathology. 25 Many studies have demonstrated that the larger the ccRCC lesion, the more likely it is to be associated with a higher grade. 28,29 The introduction of tumor size undoubtedly improved the predictive performance of the model.…”

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

“…As one of the most frequent malignancies, renal cell carcinoma (RCC) accounted for approximately 2–3% of all cancers [ 1 , 2 ]. There were 80–90% of clear cell RCC (ccRCC), which is the major histological subtype of RCC [ 3 , 4 ]. Metastases occurred in about 25–30% of patients with ccRCC at first diagnosis; besides, 20–30% of localized RCC patients have metastases after treatment [ 5 ].…”

Knockdown of lncRNA HOTAIR sensitizes breast cancer cells to ionizing radiation through activating miR-218

“…Out of cancer-associated lncRNAs, HOTAIR (HOX antisense intergenic RNA) is the most up-regulated in breast cancer [13]. And the aberrant expression of HOTAIR was related with the poor prognosis of breast [14,15]. HOTAIR could also regulate cancer proliferation as well as metastasis, and confer to tamoxifen resistance [16,17].…”