Ultrasonic predictors of WHO/ISUP classification of clear cell renal cell carcinoma

doi:10.3877/cma.j.issn.1672-6448.2021.06.011

Abstract

Abstract:

Objective

To identify the ultrasonic predictors of clear cell renal cell carcinoma (CCRCC) and pathological WHO/ISUP classification.

Methods

Eighty-seven patients with CCRCC confirmed by surgical pathology from January 2017 to November 2020 were selected retrospectively. All patients were examined by conventional ultrasound and CEUS before operation. According to WHO/ISUP pathological classification, the patients were divided into low-grade group (grades 1 and 2) and high-grade group (grades 3 and 4). Single factor analysis were used to compare the characteristics of conventional ultrasound and CEUS in the two groups, and the ultrasonic predictive factors of WHO/ISUP pathological classification of CCRCC patients were identified by logistic multivariate regression method. The regression equation was obtained and the area under the ROC curve of regression model was calculated.

Results

Among the 87 CCRCC cases, 19 (21.8%) were grade 1, 47 (54.0%) were grade 2, 18 (20.8%) were grade 3, and 3 (3.4%) were grade 4. Based on the pathological findings, the 87 patients were divided into the low-grade group with 66 patients and the high-grade group with 21 patients. Univariate analysis showed that there were significant differences between the low-grade and high-grade groups in the mean diameter of the tumor, CEUS contrast-enhanced uniformity, and non-enhancing area ratio (mean diameter of the tumor: Z=-2.326, P=0.020; CEUS enhancement uniformity: χ²=5.165, P=0.023; non-enhancing area ratio: χ²=12.167, P＜0.001). Logistic multivariate regression analysis showed that mean tumor diameter (OR=1.047, 95% CI: 1.002-1.094) and non-enhancing area ratio (OR=3.951, 95% CI: 1.279-14.489) were independent predictors of WHO/ISUP .The logistic regression equation was derived as follows: logistic (P)=-3.322+1.047X₄+3.951X₁₁, for which the area under the ROC curve was 0.824 (95% CI: 0.726-0.921).

Conclusion

A larger diameter of the mass and CEUS non-enhancing area ratio ≥50% predispose to high-grade CCRCC. The application of conventional ultrasound and CEUS examination is helpful to preoperatively predict the WHO/ISUP grade of CCRCC, which in turn may provide a reference basis for the selection of clinical treatments.

Key words: Clear cell renal cell carcinoma, Ultrasonography, Contrast-enhanced ultrasound, Pathological grade

Yang Liu, Li Zhu, Jianchun Li, Li Wang, Weinan Chen, Ligang Wang, Chengzhong Peng, Xiaoming. Fan. Ultrasonic predictors of WHO/ISUP classification of clear cell renal cell carcinoma[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2021, 18(06): 605-610.

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URL: https://chaosheng.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1672-6448.2021.06.011

https://chaosheng.cma-cmc.com.cn/EN/Y2021/V18/I06/605

Figures/Tables 8

组别	例数	性别（例）		年龄（岁， $x ¯$ ±s）	生长部位（例）
组别	例数	男	女	年龄（岁， $x ¯$ ±s）	左肾	右肾
低级别组	66	47	19	57.06±12.37	30	36
高级别组	21	13	8	52.76±13.45	9	12
检验值		χ²=0.645		t=1.358	χ²=0.043
P值		0.422		0.178	0.835

组别	例数	性别（例）		年龄（岁， $x ¯$ ±s）	生长部位（例）
组别	例数	男	女	年龄（岁， $x ¯$ ±s）	左肾	右肾
低级别组	66	47	19	57.06±12.37	30	36
高级别组	21	13	8	52.76±13.45	9	12
检验值		χ²=0.645		t=1.358	χ²=0.043
P值		0.422		0.178	0.835

组别	例数	瘤体平均直径［mm，M（Q₂₅，Q₇₅）］	回声类型（例）				肿瘤生长方式（例）
组别	例数	瘤体平均直径［mm，M（Q₂₅，Q₇₅）］	高	等	低	混合	外生性	内生性
低级别组	66	24.00（16.25，33.50）	24	8	28	6	31	35
高级别组	21	39.33（30.67，50.33）	4	3	11	3	12	9
检验值		Z=-2.326	χ²＝2.311				χ²＝0.660
P值		0.020	0.510				0.417

超声造影特征	低级别组（n=66）	高级别组（n=21）	χ²值	P值
增强程度			0.675	0.411
高增强	44（66.7）	16（76.2）
低、等增强	22（33.3）	5（23.8）
灌注时相			0.142	0.707
快进	41（62.1）	14（66.7）
等、慢进	25（37.9）	7（33.3）
消退时相			0.692	0.405
快退	32（48.5）	8（38.1）
等、慢退	34（51.5）	13（61.9）
增强方式			5.165	0.023
均匀	31（47.0）	4（19.0）
非均匀	35（53.0）	17（81.0）
非增强区比值			12.167	0.000
＜50%	51（77.3）	10（47.6）
≥50%	15（22.7）	11（52.4）
环状增强			1.921	0.166^b
有	18（27.3）	2（9.5）
无	48（72.7）	19（90.5）

因素	变量名	赋值
病理分级	Y	低级别组=1，高级别组=2
性别	X₁	男=1，女=2
年龄	X₂	连续性变量未赋值
肿瘤生长部位	X₃	左肾=1，右肾=2
瘤体平均直径	X₄	连续性变量未赋值
回声类型	X₅	高回声=1，等回声=2，低回声=3，混合回声=4
肿瘤生长方式	X₆	外生性=1，内生性=2
灌注相增强程度	X₇	高增强=1，低、等增强=2
灌注时相	X₈	快进=1，等、慢进=2
消退时相	X₉	快退=1，等、慢退=2
增强方式	X₁₀	均匀=1，非均匀=2
非增强区比值	X₁₁	＜50%=1，≥50%=2
环状增强	X₁₂	无=1，有=2

变量	系数	标准误	Wald卡方值	P值	OR值	95%CI
瘤体平均直径	0.064	0.022	4.253	0.039	1.047	1.002~1.094
非增强区比值	1.374	0.645	0.033	0.033	3.951	1.279~14.489
常数项	-3.322	0.756	19.318	0.000	0.036

References 14

1	Chen C, Kang Q, Xu B, et al. Differentiation of low- and high-grade clear cell renal cell carcinoma: tumor size versus CT perfusion parameters [J]. Clin Imaging, 2017, 46: 14-19.
2	O'Neal D, Cohen T, Peterson C, et al. Contrast-enhanced ultrasound-guided radiofrequency ablation of renal tumors [J]. J Kidney Cancer VHL, 2018, 5(1): 7-14.
3	曹洪丽, 陈林, 詹嘉, 等. 超声造影特征预测肾透明细胞癌Fuhrman分级的价值 [J]. 中国超声医学杂志, 2019, 35(11): 1008-1011.
4	Moch H, Cubilla AL, Humphrey PA, et al. The 2016 WHO classification of tumours of the urinary system and male genital organs—part A: renal, penile, and testicular tumours [J]. Eur Urol, 2016, 70(1): 93-105.
5	Khor LY, Dhakal HP, Jia X, et al. Tumor necrosis adds prognostically significant information to grade in clear cell renal cell carcinoma: a study of 842 consecutive cases from a single institution [J]. Am J Surg Pathol, 2016, 40(9): 1224-1231.
6	Oh S, Sung DJ, Yang KS, et al. Correlation of CT imaging features and tumor size with Fuhrman grade of clear cell renal cell carcinoma [J]. Acta Radio, 2017, 58(3): 376-384.
7	Zhang X, Wang Y, Yang L, et al. Delayed enhancement of the peritumoural cortex in clear cell renal cell carcinoma: correlation with Fuhrman grade [J]. Clinical Radio, 2018, 73(11): 982.e1-982.e7.
8	Wei SP, Xu CL, Zhang Q, et al. Contrast-enhanced ultrasound for differentiating benign from malignant solid small renal masses: comparison with contrast-enhanced CT [J]. Abdom Radiol, 2017, 42(8): 2135-2145.
9	杨斌, 徐超丽. 肾脏疾病超声诊断 [J/CD]. 中华医学超声杂志(电子版), 2017, 14(9): 641-643.
10	Yue Z, Kapur P, Yuan Q, et al. Tumor vascularity in renal masses: correlation of arterial spin-labeled and dynamic contrast-enhanced magnetic resonance imaging assessments [J]. Clin Genitourin Canc, 2016, 14(1): e25-e36.
11	Wu J, Xu WH, Wei Y, et al. An integrated score and nomogram combining clinical and immunohistochemistry factors to predict high ISUP grade clear cell renal cell carcinoma [J]. Front Oncol, 2018, 18: 634.
12	潘宏, 聂芳, 董甜甜, 等. 肾透明细胞癌的超声造影特点与肿瘤侵袭性的关系 [J]. 中国超声医学杂志, 2016, 32(5): 447-450.
13	Jiang J, Chen Y, Zhou Y, et al. Clear cell renal cell carcinoma: contrast-enhanced ultrasound features relation to tumor size [J]. Eur J Radiol, 2010, 73(1): 162-167.
14	徐建红, 姜丽娜, 靳霞, 等. 小肾癌超声表现与病理学改变的关系 [J/CD]. 中华医学超声杂志(电子版), 2017, 14(6): 468-471.

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