Oh Saelin, Sung Deuk Jae, Yang Kyung Sook, Sim Ki Choon, Han Na Yeon, Park Beom Jin, Kim Min Ju, Cho Sung Bum
1 Department of Radiology, Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
2 Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea.
Acta Radiol. 2017 Mar;58(3):376-384. doi: 10.1177/0284185116649795. Epub 2016 Jul 19.
Background Identification of clinical features to determine the aggressive potential of tumors is highly warranted to stratify patients for adequate treatment. Computed tomography (CT) imaging features of clear cell renal cell carcinoma (ccRCC) may contribute to personalized risk assessment. Purpose To assess the correlation between CT imaging features and Fuhrman grade of ccRCC, and to identify the predictors of high Fuhrman grade in conjunction with tumor size. Material and Methods CT scans of 169 patients with 173 pathologically proven ccRCCs were retrospectively reviewed in consensus by two radiologists for the presence of intratumoral necrosis and intratumoral cyst and tumor size. Histologic grade was classified as either low (Fuhrman grade I or II) or high (Fuhrman grade III or IV). Statistical significance was evaluated by using univariate, multivariate regression, receiver operating characteristic (ROC) curve, and Spearman correlation analyses. Results On CT, 20 of the 173 tumors had intratumoral cysts, 60 had intratumoral necrosis, and 93 showed entirely solid tumors. The odds of high grade were higher with intratumoral necrosis and entirely solid tumor than with intratumoral cyst ( P < 0.03). Intratumoral necrosis showed a significantly high odds ratio of 25.73 for high Fuhrman grade. The ROC curve showed a threshold tumor size of 36 mm to predict high Fuhrman grade for overall tumors (area under the ROC curve, 0.70). In ccRCCs with intratumoral necrosis or cyst, tumor size did not significantly correlate with Fuhrman grade. Conclusion Intratumoral necrosis on CT was a strong and independent predictor of biologically aggressive ccRCCs, irrespective of tumor size.
确定肿瘤侵袭潜能的临床特征对于对患者进行分层以实施适当治疗非常必要。透明细胞肾细胞癌（ccRCC）的计算机断层扫描（CT）成像特征可能有助于个性化风险评估。
评估CT成像特征与ccRCC的Fuhrman分级之间的相关性，并结合肿瘤大小确定高Fuhrman分级的预测因素。
对169例经病理证实为ccRCC的173个肿瘤的CT扫描进行回顾性分析，由两名放射科医生共同评估瘤内坏死、瘤内囊肿和肿瘤大小的情况。组织学分级分为低级别（Fuhrman I级或II级）或高级别（Fuhrman III级或IV级）。采用单因素、多因素回归、受试者操作特征（ROC）曲线和Spearman相关性分析评估统计学意义。
在CT上，173个肿瘤中有20个有瘤内囊肿，60个有瘤内坏死，93个显示为完全实性肿瘤。与瘤内囊肿相比，瘤内坏死和完全实性肿瘤的高级别几率更高（P < 0.03）。瘤内坏死显示高Fuhrman分级的优势比显著高，为25.73。ROC曲线显示，总体肿瘤预测高Fuhrman分级的肿瘤大小阈值为36 mm（ROC曲线下面积为0.70）。在有瘤内坏死或囊肿的ccRCC中，肿瘤大小与Fuhrman分级无显著相关性。
CT上的瘤内坏死是生物学侵袭性ccRCC的强有力且独立的预测因素，与肿瘤大小无关。
