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Tumor margin irregularity degree is an important preoperative predictor of adverse pathology for clinical T1/2 renal cell carcinoma and the construction of predictive model

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Abstract

Purpose

To explore the critical role of the tumor margin irregularity degree (TMID) of renal tumors in predicting adverse pathology of patients with clinical T1/2 (cT1/2) renal cell carcinoma (RCC).

Methods

A total of 821 patients with cT1/2 RCC undergoing nephrectomy in the Second Hospital of Tianjin Medical University between January 2017 and December 2020 were reviewed. The tumor margin irregularity (TMI) was classified into renal mass with locally raised protrusion and smooth margin called ‘lobular’, sharply and unsmooth nodular margin called ‘spiculation’, blurred margins between tumor and renal parenchyma or a completely irregular and non-elliptical shape. The ratio between the number of irregular cross-sections (X) and the number of total cross-sections from top to bottom occupied (Y) was defined as TMID (X/Y). The logistic regression was performed to determine the independent predictors of adverse pathology, and the Kaplan–Meier curve and log-rank test were used to analyze the survival outcomes.

Results

Among 821 cT1/2 RCC patients, 245 (29.8%) had adverse pathology. The results of the univariate and multivariate logistic regressions showed that the age, tumor size, hemoglobin, and TMID were the independent predictors of adverse pathology. Incorporation of TMID could increase the discrimination of the predictive model with the area under curve (AUC) of ROC curves increasing from 0.725 to 0.808. Patients with adverse pathology or higher TMID both had significantly shorter recurrence-free survival (RFS).

Conclusion

The nomogram model incorporated with TMID for predicting adverse pathology could increase its discrimination, calibration, and clinical application values, compared with the models without TMID.

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Data availability

The datasets used and/or analyzed during the current study are available on the Supplementary file 5.

Abbreviations

TMID:

Tumor margin irregularity degree

RCC:

Renal cell carcinoma

RFS:

Recurrence-free survival

PN:

Partial nephrectomy

RN:

Radical nephrectomy

CSS:

Cancer-specific survival

AS:

Active surveillance

sRCC:

Small renal cell carcinoma

CT:

Computerized tomography

MRI:

Magnetic resonance imaging

CID:

Contour irregularity degree

pRCC:

Papillary renal cell carcinoma

BMI:

Body mass index

IQR:

Interquartile range

VIF:

Variance inflation factor

ROC:

Receiver operating characteristic

DCA:

Decision curve analysis

AUC:

Area under curve

NLR:

Neutrophil-to-lymphocyte ratio

AGR:

Albumin-to-globulin ratio

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Funding

This study was supported by the Tianjin Municipal Natural Science Foundation (grant no.21JCYBJC01690).

Author information

Author notes

  1. Keruo Wang, Guixin Wang and Yaru Liu have contributed equally to this work.

Authors and Affiliations

  1. Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, 300211, China

    Keruo Wang, Guixin Wang, Liang Dong, Yuanjie Niu & Gang Li

  2. Department of Emergency, The Second Hospital of Tianjin Medical University, Tianjin Medical University, Tianjin, 300211, China

    Yaru Liu

Authors
  1. Keruo Wang
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  2. Guixin Wang
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  3. Yaru Liu
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  4. Liang Dong
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  5. Yuanjie Niu
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  6. Gang Li
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Contributions

KRW: protocol/project development, data collection or management, data analysis, manuscript writing; GXW: protocol/project development, data collection or management, data analysis; YRL: data collection or management, data analysis, manuscript writing; LD: data collection or management, data analysis; YJN and GL: protocol/project development, data analysis, manuscript editing.

Corresponding authors

Correspondence to Yuanjie Niu or Gang Li.

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Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

This study was approved by the Institutional Review Board of Tianjin Medical University. All procedures followed were in accordance with the Helsinki Declaration of 1964 and later versions.

Consent for publication

Informed consent was obtained from all individual participants enrolled in the study.

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Supplementary Information

Below is the link to the electronic supplementary material.

345_2023_4698_MOESM1_ESM.tif

Supplementary file1 Supplementary Figure 1. Flowchart of clinical T1/2 RCC patients treated with nephrectomy included in the study. RCC, renal cell carcinoma (TIF 932 KB)

345_2023_4698_MOESM2_ESM.tif

Supplementary file2 Supplementary Figure 2. Irregular tumor margin of RCC in contrast-enhanced CT (A) A mass with smooth margin and prominent nodules from part of it; (B) A mass with unsmooth margin and sharply small nodular from part of it; (C) A mass with blurred margin; (D) A mass with completely irregular and non-elliptical shape. RCC, renal cell carcinoma (TIF 2372 KB)

345_2023_4698_MOESM3_ESM.tif

Supplementary file3 Supplementary Figure 3. Kaplan-Meier curve of RFS for cT1/2 RCC patients stratified by (A) adverse pathology, (B) TMID, (C) age, (D) tumor size, (E) hemoglobin and (F) ‘N’ score. RCC, renal cell carcinoma; TMID, tumor margin irregularity degree; RFS, recurrence-free survival; AUC, area under curve (TIF 854 KB)

Supplementary file4 (DOCX 33 KB)

Supplementary file5 (CSV 76 KB)

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Wang, K., Wang, G., Liu, Y. et al. Tumor margin irregularity degree is an important preoperative predictor of adverse pathology for clinical T1/2 renal cell carcinoma and the construction of predictive model. World J Urol 42, 64 (2024). https://doi.org/10.1007/s00345-023-04698-0

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