To explore whether sex-specific abdominal visceral fat composition on CT can predict the Fuhrman nuclear grade of clear cell renal cell carcinoma (ccRCC).
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.
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.
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.
• 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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Area under the ROC curve
Body mass index
Clear cell renal cell carcinoma
Oestrogen receptor alpha
Oestrogen receptor beta
Renal cell carcinoma
Relative visceral fat area
Subcutaneous fat area
The Cancer Imaging Archive Kidney Renal Clear Cell Carcinoma
Total fat area
Visceral adipose tissue
Visceral fat area
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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).
The scientific guarantor of this publication is Dr. Ruimeng Yang.
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.
Written informed consent was waived by the Institutional Review Board.
Institutional Review Board approval was obtained.
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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
- Carcinoma, renal cell
- Obesity, abdominal
- Tomography, X-ray computed
- Neoplasm grading