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| Analysis of prognosis related CT features of renal clear cell carcinoma |
| REN Jin-wu, MA Cong-min, ZHANG Li-hong, MA Li-xin, WANG Qian, WANG Xin-gang |
| Baoding First Central Hospital of Hebei Province, Baoding Hebei 071051, China |
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Abstract Objective: To investigate the relationship between CT features and the survival rate of patients with RCC, and to evaluate its prognostic value. Methods: The CT findings of 208 cases of renal clear cell carcinoma confirmed by surgery and pathology were retrospectively analyzed, including two types of CT features relevant to tumor T staging or not. CT features associated with stage T could be false negative or positive due to the degrees of aggression, leading to errors in staging. The survival of T3a patients were evaluated. Relationship of clinical data, histological types and CT signs was evaluated with survival rate by Kaplan-Meier survial analysis to obtain the survival curve. The comparison of survival rate was tested by chi-square test. For statistically significant single factors, multifactor unconditional logistic regression analysis was adopted to make a COX model. Results: The critical error of CT-T staging was in T3a stage. There were 42 T3a-CT patients and 24 T3a patients(only pathological diagnosis) in all 66 T3a patients. The latter had 18 patients in T2 stage and 6 patients in T1 stage on CT stage. The patients of T3a stage diagnosed by CT were different from the patients of T3a stage only diagnosed by pathology or the patients of T2 stage in survival rates(P<0.05). The patients of T2 stage showed no significant difference with the patients of T3a stage only diagnosed by pathology(P>0.05), and there was no overlapping between the survival curves in the three groups. Single factor analysis results showed that 5 year survival rate of renal cancer was closely related to histological types, tumor size, renal capsule penetration, renal sinus invasion, renal vein invasion, inferior vena cava invasion, extensive necrosis of tumor, cystic degeneraton of tumor, peritumoral invasion, peritumoral neovascularity. Multifactor logistic regression showed that the prognosis of patients with renal clear cell carcinoma was closely related to histological types, tumor size, renal capsule penetration, renal vein invasion, inferior vena cava invasion, cystic degeneraton of tumor, peritumoral invasion, peritumoral neovascularity(P<0.05). Conclusion: Tumor size, renal capsule penetration, renal vein invasion, and inferior vena cava invasion were relatively independent risk factors for renal clear cell carcinoma. The false negative CT sign showed better prognosis than the positive CT feature in T3a. Cystic degeneration, peritumoral invasion, and peritumoral neovascularity were relatively independent risk factors. Peritumoral stranding and peritumoral neovascularity reduced the survival rate. Cystic degeneration is a sign of good prognosis.
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Received: 21 March 2017
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2018, Vol. 29 
