背景:由于去除乳头状肾细胞癌(pRCC)的亚分类,手术治疗后局部pRCC的生存预后变得不充分.肌肉减少症被广泛评估,并被证明是RCC患者预后的预测因素。因此,我们全面研究了局部pRCC的身体成分参数的生存预测。
方法:纳入2012年2月至2022年2月在我们中心病理诊断为pRCC的患者。身体成分参数,包括骨骼肌指数(SMI),皮下脂肪组织(SAT),和肾周脂肪组织(PRAT),通过术前计算机断层扫描(CT)的图像进行测量。主要结局设定为无进展生存期(PFS),并使用Youden从受试者工作特征曲线(ROC)曲线计算身体成分参数的截止值。进行单因素和多因素Cox比例回归分析以探索生存预测的独立危险因素。然后,重要因素用于构建预后列线图.通过Harrell的C指数评估列线图的性能,校准曲线和时间依赖性ROC曲线。
结果:共纳入105例患者进行分析。中位随访时间为30.48个月,25例(23.81%)患者出现癌症进展。肌肉减少率为74.29%。单变量Cox分析确定性别,PRAT,SAT,骨骼肌(SM),少肌症,外科技术,肿瘤直径与进展有关。进一步的多变量分析表明,肌肉减少症(风险比[HR]0.15,95%置信区间[CI]0.03-0.66),SAT(HR6.36,95%CI2.39-16.93),PRAT(HR4.66,95%CI1.77-12.27),肿瘤直径(HR0.35,95%CI0.14-0.86),手术技术(HR2.85,95%CI1.06-7.64)是癌症进展的独立危险因素。然后,构建基于独立危险因素的预后列线图,预测进展的C指数为0.831(95%CI0.761-0.901),代表合理的歧视,校正曲线,与时间相关的ROC曲线验证了列线图的良好性能。
结论:预后列线图,包括少肌症,SAT,PRAT,肿瘤直径,和手术技术,目的是计算局部pRCC患者的进展概率,需要进一步的外部验证以供将来临床使用。
BACKGROUND: Because of to the removal of subclassification of papillary renal cell carcinoma (pRCC), the survival prognostification of localized pRCC after surgical treatment became inadequate. Sarcopenia was widely evaluated and proved to be a predictive factor for prognosis in RCC patients. Therefore, we comprehensively investigated the survival prediction of the body composition parameters for localized pRCC.
METHODS: Patients pathologically diagnosed with pRCC between February 2012 and February 2022 in our center were enrolled. The body composition parameters, including skeletal muscle index (SMI), subcutaneous adipose tissue (SAT), and perirenal adipose tissue (PRAT), were measured by the images of preoperative computed tomography (CT). The primary outcome was set as progression-free survival (PFS), and the cutoff values of body composition parameters were calculated by using the Youden from receiver operating characteristic curve (ROC) curves. Univariate and multivariate Cox proportional regression analyses were performed to explore independent risk factors for survival prediction. Then, significant factors were used to construct a prognostic nomogram. The performance of the nomogram was evaluated by Harrell\'s C-index, calibration curves and time-dependent ROC curves.
RESULTS: A total of 105 patients were enrolled for analysis. With a median follow-up time of 30.48 months, 25 (23.81%) patients experienced cancer progression. The percentage of sarcopenia was 74.29%. Univariate Cox analysis identified that gender, PRAT, SAT, skeletal muscle (SM), sarcopenia, surgical technique, and tumor diameter were associated with progression. Further multivariate analysis showed that sarcopenia (hazard ratio [HR] 0.15, 95% confidence interval [CI] 0.03-0.66), SAT (HR 6.36, 95% CI 2.39-16.93), PRAT (HR 4.66, 95% CI 1.77-12.27), tumor diameter (HR 0.35, 95% CI 0.14-0.86), and surgical technique (HR 2.85, 95% CI 1.06-7.64) were independent risk factors for cancer progression. Then, a prognostic nomogram based on independent risk factors was constructed and the C-index for progression prediction was 0.831 (95% CI 0.761-0.901), representing a reasonable discrimination, the calibration curves, and the time-dependent ROC curves verified the good performance of the nomogram.
CONCLUSIONS: A prognostic nomogram, including sarcopenia, SAT, PRAT, tumor diameter, and surgical technique, was constructed to calculate the probability of progression for localized pRCC patients and needs further external validation for clinical use in the future.