Clear cell renal cell carcinoma: the value of sex-specific abdominal visceral fat measured on CT for prediction of Fuhrman nuclear grade

Abstract

Objective

To explore whether sex-specific abdominal visceral fat composition on CT can predict the Fuhrman nuclear grade of clear cell renal cell carcinoma (ccRCC).

Methods

One hundred seventy-one patients (123 males and 48 females) from four hospitals (multicentre group) and 159 patients (109 males and 50 females) from the cancer imaging archive (TCIA-KIRC group) with pathologically proven ccRCC (multicentre: 124 low grade and 47 high grade; TCIA-KIRC: 79 low grade and 80 high grade) were retrospectively included. Abdominal fat was segmented into subcutaneous fat area (SFA) and visceral fat area (VFA) on CT using ImageJ. The total fat area (TFA) and relative VFA (rVFA) were then calculated. Clinical characteristics (age, sex, waist circumference and maximum tumour diameter) were also assessed. Univariate and multivariate logistic regression analyses were performed to identify the association between general or sex-specific visceral fat composition and Fuhrman grade.

Results

Females with high-grade ccRCC from the multicentre group had a higher rVFA (42.4 vs 31.3, p = 0.001) than those with low-grade ccRCC after adjusting for age. There was no significant difference in males. The rVFA remained a stable and independent predictor for females high-grade ccRCC in both the univariate (multicentre: OR 1.205, 95% CI 1.074–1.352, p = 0.001; TCIA-KIRC: OR 1.171, 95% CI 1.016–1.349, p = 0.029) and multivariate (multicentre: OR 1.095, 95% CI 1.024–1.170, p = 0.003; TCIA-KIRC: OR 1.103, 95% CI 1.024–1.187, p = 0.010) models.

Conclusions

Sex-specific visceral fat composition has different values for predicting high-grade ccRCC and could be used as an independent predictor for females with high-grade ccRCC.

Key Points

• Visceral fat measurement (rVFA) as an independent predictor for high-grade ccRCC had good predictive power in females, but not in males.

• Sex-specific visceral fat composition was significantly associated with high-grade ccRCC in females only.

• The rVFA could be considered one of the risk factors for high-grade ccRCC for females.

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Abbreviations

AUC:

Area under the ROC curve

BMI:

Body mass index

ccRCC:

Clear cell renal cell carcinoma

ERα:

Oestrogen receptor alpha

ERβ:

Oestrogen receptor beta

RCC:

Renal cell carcinoma

rVFA:

Relative visceral fat area

SFA:

Subcutaneous fat area

TCIA-KIRC:

The Cancer Imaging Archive Kidney Renal Clear Cell Carcinoma

TFA:

Total fat area

VAT:

Visceral adipose tissue

VFA:

Visceral fat area

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Funding

This study has received funding from the National Natural Science Foundation of China (81971574), the Natural Science Foundation of Guangdong Province in China (2018A030313282), the Fundamental Research Funds for the Central Universities, SCUT (2018MS23), the Research Grant of Guangdong Food and Drug Vocational College (2018ZR019) and the Guangdong Province Medical Scientific Research Foundation (A2019465).

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Correspondence to Ruimeng Yang.

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The scientific guarantor of this publication is Dr. Ruimeng Yang.

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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.

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Written informed consent was waived by the Institutional Review Board.

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Institutional Review Board approval was obtained.

Methodology

• Retrospective

• Observational

• Multicentre study

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Hu, Z., Wu, J., Lai, S. et al. Clear cell renal cell carcinoma: the value of sex-specific abdominal visceral fat measured on CT for prediction of Fuhrman nuclear grade. Eur Radiol 30, 3977–3986 (2020). https://doi.org/10.1007/s00330-020-06747-3

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Keywords

  • Carcinoma, renal cell
  • Obesity, abdominal
  • Tomography, X-ray computed
  • Pathology
  • Neoplasm grading