Renal cell carcinoma: A nomogram for the CT imaging-inclusive prediction of indolent, non-clear cell renal cortical tumours Journal Article


Authors: Karlo, C. A.; Kou, L.; Di Paolo, P. L.; Kattan, M. W.; Motzer, R. J.; Russo, P.; Tickoo, S. K.; Akin, O.; Hricak, H.
Article Title: Renal cell carcinoma: A nomogram for the CT imaging-inclusive prediction of indolent, non-clear cell renal cortical tumours
Abstract: Aim To develop a nomogram from clinical and computed tomography (CT) data for pre-treatment identification of indolent renal cortical tumours. Patients and methods A total of 1201 consecutive patients underwent dedicated contrast-enhanced CT prior to nephrectomy for a renal cortical tumour between January 2000 and July 2011. Two radiologists evaluated all tumours on CT for size, necrosis, calcification, contour, renal vein invasion, collecting system invasion, contact with renal sinus fat, multicystic tumour architecture, nodular enhancement, and the degree of nephrographic phase enhancement. CT and clinical predictors (gender, body mass index [BMI], age) were incorporated into the nomogram. We employed multivariable logistic regression analysis to predict tumour type and internally validated the final model using the data from reader 1. External validation was performed by using all data from reader 2. We applied Wilcoxon rank sum test and Fisher's exact test to investigate for differences in tumour size, BMI, age, and differences in CT imaging features between patients with aggressive and those with indolent tumours. Results 63.6% (764/1201) of patients had clear-cell or other aggressive non-clear-cell RCC (i.e. papillary RCC type 2, unclassified RCC) and 36.4% (437/1201) had indolent renal cortical tumours (i.e. papillary RCC type 1, chromophobe RCC, angiomyolipoma, or oncocytoma). On CT, indolent tumours were significantly smaller (p < 0.001) than aggressive tumours and significantly associated with well-defined tumour contours (p < 0.001). Aggressive RCC were significantly associated with necrosis, calcification, renal vein invasion, collecting system invasion, contact with renal sinus fat, multicystic tumour architecture, and nodular enhancement (all, p < 0.001). The nomogram's concordance index (C-index) was 0.823 after internal and 0.829 after external validation. Concluding statement We present a nomogram based on 1201 patients combining CT features with clinical data for the prediction of indolent renal cortical tumours. When externally validated, this nomogram resulted in a C-index of 0.829. © 2016 Elsevier Ltd. All rights reserved.
Keywords: chromophobe; oncocytoma; renal cell carcinoma; angiomyolipoma; nomogram; ct; computed tomography; papillary; rcc; clear cell
Journal Title: European Journal of Cancer
Volume: 59
ISSN: 0959-8049
Publisher: Elsevier Inc.  
Date Published: 2016-05-01
Start Page: 57
End Page: 64
Language: English
DOI: 10.1016/j.ejca.2016.02.012
PROVIDER: scopus
PMCID: PMC4851871
PUBMED: 27016623
DOI/URL:
Notes: Article -- Export Date: 2 May 2016 -- Source: Scopus
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MSK Authors
  1. Paul Russo
    567 Russo
  2. Robert Motzer
    1172 Motzer
  3. Satish K Tickoo
    461 Tickoo
  4. Hedvig Hricak
    405 Hricak
  5. Oguz Akin
    254 Akin
  6. Christoph Alexander Karlo
    18 Karlo