To provide objective criteria for preoperative staging chest computed tomography [CCT] in patients diagnosed with renal cell carcinoma [RCC], since, in absence of established indications, the decision for preoperative CCT remains subjective.
1,946 patients elected for surgical treatment of RCC and collected in a prospective institutional database were assessed. The outcome of the study was presence of pulmonary metastases at staging CCT. A multivariable logistic regression model predicting positive CCT was fitted. Predictors consisted of preoperative clinical tumour [cT] and nodal [cN] stage, presence of systemic symptoms and platelets/haemoglobin ratio.
The rate of positive CCT was 6% (n=119). At multivariable logistic regression, ≥cT1b, cN1, systemic symptoms and haemoglobin/platelets ratio were all associated with higher risk of positive CCT (all p<0.0001). Following a 2000-sample bootstrap validation, concordance index resulted 0.88. At decision curve analysis, the net benefit of the proposed strategy was superior to the select-all and select-none strategies. Accordingly, if CCT is performed when the risk of a positive result is >1%, a negative CCT is spared in 37% of the population and a positive CCT is missed in 0.2% of the population only.
The proposed strategy estimates the risk of positive CCT at RCC staging with optimal accuracy and resulted statistically and clinically relevant. The current findings support a recommendation for CCT in patients with ≥cT1b, cN1, systemic symptoms or anaemia and thrombocythemia. Conversely, in patients with cT1a, cN0 without systemic symptoms, anaemia and thrombocythemia, CCT can be omitted. This article is protected by copyright. All rights reserved.
BJU international. 2016 Sep 29 [Epub ahead of print]
Alessandro Larcher, Paolo Dell'Oglio, Nicola Fossati, Alessandro Nini, Fabio Muttin, Nazareno Suardi, Francesco De Cobelli, Andrea Salonia, Alberto Briganti, Xu Zhang, Francesco Montorsi, Roberto Bertini, Umberto Capitanio
URI - Urological Research Institute, Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy. ., URI - Urological Research Institute, Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy., Unit of Radiology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy., Department of Urology, Clinical Division of Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China.