Department of Radiology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, 510180, Guangdong, China.
Department of Medical Devices, Guangdong Food and Drug Vocational College, Guangzhou, 510520, Guangdong, China.
Eur Radiol. 2020 Jul;30(7):3977-3986. doi: 10.1007/s00330-020-06747-3. Epub 2020 Mar 6.
To explore whether sex-specific abdominal visceral fat composition on CT can predict the Fuhrman nuclear grade of clear cell renal cell carcinoma (ccRCC).
One hundred seventy-one patients (123 males and 48 females) from four hospitals (multicentre group) and 159 patients (109 males and 50 females) from the cancer imaging archive (TCIA-KIRC group) with pathologically proven ccRCC (multicentre: 124 low grade and 47 high grade; TCIA-KIRC: 79 low grade and 80 high grade) were retrospectively included. Abdominal fat was segmented into subcutaneous fat area (SFA) and visceral fat area (VFA) on CT using ImageJ. The total fat area (TFA) and relative VFA (rVFA) were then calculated. Clinical characteristics (age, sex, waist circumference and maximum tumour diameter) were also assessed. Univariate and multivariate logistic regression analyses were performed to identify the association between general or sex-specific visceral fat composition and Fuhrman grade.
Females with high-grade ccRCC from the multicentre group had a higher rVFA (42.4 vs 31.3, p = 0.001) than those with low-grade ccRCC after adjusting for age. There was no significant difference in males. The rVFA remained a stable and independent predictor for females high-grade ccRCC in both the univariate (multicentre: OR 1.205, 95% CI 1.074-1.352, p = 0.001; TCIA-KIRC: OR 1.171, 95% CI 1.016-1.349, p = 0.029) and multivariate (multicentre: OR 1.095, 95% CI 1.024-1.170, p = 0.003; TCIA-KIRC: OR 1.103, 95% CI 1.024-1.187, p = 0.010) models.
Sex-specific visceral fat composition has different values for predicting high-grade ccRCC and could be used as an independent predictor for females with high-grade ccRCC.
• Visceral fat measurement (rVFA) as an independent predictor for high-grade ccRCC had good predictive power in females, but not in males. • Sex-specific visceral fat composition was significantly associated with high-grade ccRCC in females only. • The rVFA could be considered one of the risk factors for high-grade ccRCC for females.
探讨 CT 上性别特异性腹部内脏脂肪成分是否可预测透明细胞肾细胞癌（ccRCC）的 Fuhrman 核分级。
本研究回顾性纳入了来自四家医院（多中心组）的 171 例（123 例男性和 48 例女性）和癌症影像档案（TCIA-KIRC 组）的 159 例（109 例男性和 50 例女性）经病理证实的 ccRCC 患者（多中心组：124 例低级别和 47 例高级别；TCIA-KIRC 组：79 例低级别和 80 例高级别）。使用 ImageJ 在 CT 上对腹部脂肪进行了皮下脂肪面积（SFA）和内脏脂肪面积（VFA）的分割。然后计算总脂肪面积（TFA）和相对 VFA（rVFA）。还评估了临床特征（年龄、性别、腰围和最大肿瘤直径）。进行了单变量和多变量逻辑回归分析，以确定一般或性别特异性内脏脂肪成分与 Fuhrman 分级之间的关联。
多中心组中，高级别 ccRCC 的女性 rVFA（42.4 比 31.3，p=0.001）高于低级别 ccRCC 患者，且这种差异在男性中并不显著。在单变量（多中心：OR 1.205，95%CI 1.074-1.352，p=0.001；TCIA-KIRC：OR 1.171，95%CI 1.016-1.349，p=0.029）和多变量（多中心：OR 1.095，95%CI 1.024-1.170，p=0.003；TCIA-KIRC：OR 1.103，95%CI 1.024-1.187，p=0.010）模型中，rVFA 仍然是女性高级别 ccRCC 的稳定且独立的预测因子。
性别特异性内脏脂肪成分对预测高级别 ccRCC 具有不同的价值，可作为高级别 ccRCC 女性的独立预测因子。
rVFA（内脏脂肪面积）作为高级别 ccRCC 的独立预测因子，在女性中具有良好的预测能力，但在男性中则不然。
仅在女性中，性别特异性内脏脂肪成分与高级别 ccRCC 显著相关。
rVFA 可被视为女性高级别 ccRCC 的危险因素之一。
