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Tumor contour irregularity on preoperative imaging: a practical and useful prognostic parameter for papillary renal cell carcinoma

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Abstract

Objectives

To illustrate tumor contour irregularity on preoperative imaging with a practical method and further determine its value in predicting disease-free survival (DFS) in patients with pRCC (papillary renal cell carcinoma).

Methods

We performed a retrospective single-institution review of 267 Chinese pRCC patients between March 2009 and May 2019. Contour irregularity on cross-section was classified into smooth but distorted margin, unsmooth and sharply nodular margin, and blurred margin. Then, the ratio of the cross-section numbers of irregularity and the total tumor was defined as the contour irregular degree (CID). Cox regression and Kaplan-Meier analysis were performed to analyze the impact of CID on DFS. Then, the prognostic performance of CID was compared with pRCC risk stratification published by Leibovich et al.

Results

The median follow-up was 45 months (IQR: 23–69), in which 27 (10%) patients had metastasis or recurrence. Observed DFS rates were 95%, 90%, and 88% at 1, 3, and 5 years. The CID was an independent prognostic factor of DFS (HR = 1.048, 95% CI = 1.029–1.068, p < 0.001). The Kaplan-Meier plot showed that high-risk patients (CID ≥ 50%) tended to have a significantly shorter DFS (p < 0.001). The CID and Leibovich’s pRCC model for DFS prediction had a C-index of 0.934 (95% CI = 0.907–0.961) and 0.833 (95% CI = 0.739–0.927) respectively.

Conclusions

With our standard and practical method, the CID can be a reliable imaging marker for DFS prediction in patients with pRCC.

Key Points

• The updated contour irregularity was an independent parameter for predicting disease-free survival in patients with pRCC.

• High-risk pRCC patients (contour irregular degree ≥ 50%) tended to have a shorter disease-free survival.

• Tumor contour irregularity in pRCC risk stratification outperformed Leibovich’s model from our cohort.

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Abbreviations

CI:

Confidence interval

CID:

Contour irregular degree

DFS:

Disease-free survival

HR:

Hazard ratio

IQR:

Interquartile range

OR:

Odds ratio

PRCC:

Papillary renal cell carcinoma

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Acknowledgments

The authors thank Yeqing Xu for his valuable collaboration with the pictures.

Funding

This study has received funding by Scientific Research Cultivation and Medical Innovation Project of Fujian Province (No. 2019CXB33), Fujian Province Department of Science and Technology (No. 2019D025), Medical and Health Key Project of Xiamen (No.3502Z20199716), and Shanghai Municipal Health Commission (No.2019SY073).

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Author notes

  1. Chenchen Dai and Jiaqi Huang contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Medical Imaging Institute, No180, Fenglin Road, Xuhui District, Shanghai, China

    Chenchen Dai, Qinxuan Tan, Mengsu Zeng & Jianjun Zhou

  2. Department of Urology, Zhongshan Hospital, Fudan University, No180, Fengling Road, Xuhui District, Shanghai, China

    Jiaqi Huang, Yaohui Li, Sihong Zhang, Xiaoyi Hu, Jianming Guo & Hang Wang

  3. Department of Pathology, Zhongshan Hospital, Fudan University, No180, Fenglin Road, Xuhui District, Shanghai, China

    Jun Hou

  4. Department of Radiology, Xiamen Branch, Zhongshan Hospital, Fudan University, No 668, Jinhu Road, Huli District, Xiamen, Fujian province, China

    Qiying Tang & Jianjun Zhou

Authors
  1. Chenchen Dai
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  2. Jiaqi Huang
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  9. Jianming Guo
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  10. Mengsu Zeng
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  11. Hang Wang
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Corresponding authors

Correspondence to Hang Wang or Jianjun Zhou.

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Guarantor

The scientific guarantor of this publication is Jianjun Zhou.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was not required for this study because this study is a retrospective study and patients have full autonomy in decision-making.

Ethical approval

Institutional Review Board approval was not required because this study is a retrospective study and patients have full autonomy in decision-making.

Methodology

• retrospective

• diagnostic or prognostic study

• performed at one institution

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Dai, C., Huang, J., Li, Y. et al. Tumor contour irregularity on preoperative imaging: a practical and useful prognostic parameter for papillary renal cell carcinoma. Eur Radiol 31, 3745–3753 (2021). https://doi.org/10.1007/s00330-020-07456-7

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  • DOI: https://doi.org/10.1007/s00330-020-07456-7

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