Association of tumor grade, enhancement on multiphasic CT and microvessel density in patients with clear cell renal cell carcinoma
Association of tumor grade, enhancement on multiphasic CT and microvessel density in patients with clear cell renal cell carcinoma
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DOI：
10.1007/s00261-019-02271-1
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发表时间：
2019-10-24
影响因子：
2.4
通讯作者：
Raman, Steven S.
中科院分区：
文献类型：
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作者：
Coy, Heidi;Young, Jonathan R.;Raman, Steven S.
目的肾透明细胞癌占肾细胞癌亚型的近90%，预后最差，转移潜能最高。CcRCC患者最强烈的预后因素包括组织学亚型和Fuhrman分级，这些因素被纳入预后模型。由于肾细胞癌是一种高度血管化的肿瘤，由于病变的血流动力学和微血管密度(MVD)的不同，多层螺旋CT(MDCT)的增强模式可能会有所不同。这可以提供一种非侵入性的方法来表征MDCT上偶然检测到的低级别和高级别的CCRCC。本研究的目的是确定MDCT增强参数、肾小管细胞癌微血管密度和Fuhrman分级之间的相关性，以确定其在评估体内肿瘤血管和分级中的应用和价值。方法在这项符合HIPAA的、机构评审委员会批准的放弃知情同意的回顾性研究中，127例连续的89例低级别(LG)和43例高级别(HG)的慢性肾癌患者接受了术前四期MDCT检查。获得每个肿瘤的三维感兴趣体积(VOI)和绝对强化，并评估每个阶段的强化洗入/洗出。采用免疫组织化学方法对标本进行微血管密度定量。采用线性回归和皮尔逊相关分析研究3D VOI增强与MVD之间的相关性。逐步Logistic回归分析确定了HG、CcRCC的独立预测因素。报告了95%顺应性的临界值和优势比(OR)。用受试者算子特征(ROC)和曲线下面积(AUC)评价在逐步Logistic回归分析中表现最好的临床、放射学和病理特征。结果肾造影期绝对强化52.1Hounsfield单位(HU)(HR 0.979，95%CI 0.964~0.994，p值=0.006)，病灶大小4.3 cm(HR 1.450，95%CI 1.211~1.738，p值0.001)，瘤内微血管密度及Lt；15%(HR 0.932，95%CI 0.867~1.002，p值=0.058)是HG ccRCC的独立预测因素，其AUC值为0.818(95%CI 0.725~0.911)。HG ccRCC在增强后各期的3D VOI增强与微血管密度之间存在显著相关性(r(2)=0.238~0.455，p<；0.05)。结论术前MDCT肾造影期3D VOI获得的整个病变的绝对强化可以提供一个重要的、独立的预测高级别透明细胞肾细胞癌的定量数据，并可用于评估体内肿瘤的血管密度和分级。
Purpose Clear cell renal cell carcinoma (ccRCC) comprises nearly 90% of all diagnosed RCC subtypes and has the worst prognosis and highest metastatic potential. The strongest prognostic factors for patients with ccRCC include histological subtype and Fuhrman grade, which are incorporated into prognostic models. Since ccRCC is a highly vascularized tumor, there may be differences in enhancement patterns on multidetector CT (MDCT) due to the hemodynamics and microvessel density (MVD) of the lesions. This may provide a noninvasive method to characterize incidentally detected low- and high-grade ccRCCs on MDCT. The purpose of our study was to determine the correlation between MDCT enhancement parameters, ccRCC MVD, and Fuhrman grade to determine its utility and value in assessing tumor vascularity and grade in vivo. Methods In this retrospective, HIPAA-compliant, institutional review board-approved study with waiver of informed consent, 127 consecutive patients with 89 low-grade (LG), and 43 high-grade (HG) ccRCCs underwent preoperative four-phase MDCT. A 3D volume of interest (VOI) was obtained for every tumor and absolute enhancement and the wash-in/wash-out of enhancement for each phase was assessed. Immunohistochemistry on resected specimens was used to quantify MVD. Linear regression and Pearson correlation were used to investigate the strength of the association between 3D VOI enhancement and MVD. Stepwise logistic regression analysis determined independent predictors of HG ccRCC. Cut-off values and odds Ratio (OR) with 95% CIs were reported. The clinical, radiomic, and pathologic features with the highest performance in the stepwise logistic regression analysis were evaluated using receiver operator characteristics (ROC) and area under the curve (AUC). Results Absolute enhancement in the nephrographic phase < 52.1 Hounsfield Units (HU) (HR 0.979, 95% CI 0.964-0.994, p value = 0.006), lesion size > 4.3 cm (HR 1.450, 95% CI 1.211-1.738, p value < 0.001), and an intratumoral MVD < 15% (HR 0.932, 95% CI 0.867-1.002, p value = 0.058) were independent predictors of HG ccRCC with an AUC of 0.818 (95% CI 0.725-0.911). HG ccRCCs had a significant association between 3D VOI enhancement and MVD in each post-contrast phase (r(2) = 0.238 to 0.455, p < 0.05). Conclusions Absolute enhancement of the entire lesion obtained from a 3D VOI in the nephrographic phase on preoperative MDCT can provide quantitative data that are a significant, independent predictor of a high-grade clear cell RCC and can be used to assess tumor vascularity and grade in vivo.