Preoperative Computed Tomography Assessment for Perinephric Fat Invasion: Comparison With Pathological Staging

Landman, Jaime; Park, Jae Young; Zhao, Chang; Baker, Molly; Hofmann, Martin R.; Helmy, Mohammad; Lall, Chandana; Bozoghlanian, Mari; Okhunov, Zhamshid

doi:10.1097/rct.0000000000000588

Cited by 12 publications

(6 citation statements)

References 16 publications

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“…4) We also had concerns about whether the outcome distinguished by FAI PTAT was due to peri-nephric fat invasion. Landman and colleagues indicated that peri-nephric soft-tissue stranding was a significant factor for predicting peri-nephric fat invasion, especially in tumors 4 cm or less ( 23 ). However, the data was so controversial that Bradley et al.…”

Section: Discussionmentioning

confidence: 99%

Fat Attenuation Index of Renal Cell Carcinoma Reveals Biological Characteristics and Survival Outcome

Wang

Yu²,

Hu³

et al. 2022

Front. Oncol.

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PurposeThe computed tomography fat attenuation index (FAI) is an ideal quantifiable imaging factor to identify the inflammation degree of peri-tumor adipose tissue. We aimed to verify whether FAI could reflect peri-tumor adipose inflammation, predict the survival outcome of renal cell carcinoma (RCC), and discover transcriptomic features of tumor tissues and adjacent adipocytes.Materials and MethodsTwo clinical cohorts (Fudan University Shanghai Cancer Center [FUSCC] cohort [n=129] and TCGA cohort [n=218]) were used to explore the association between FAI and clinical outcome. A prospective cohort (n = 19) was used to discover the molecular phenotyping of peri-tumor adipose tissue and tumor tissue according to their FAI value. A clinical cohort (n = 32) in which patients received cyto-reductive surgery was used to reveal the dynamic change of FAI.ResultsA high peri-tumor FAI was significantly associated with a worse outcome in both the FUSCC (HR = 2.28, p = 0.01) and the TCGA cohort (HR = 2.24, p <0.001). The analysis of the RNA expression of paired RCC tissue and peri-tumor fat tissue showed synchronized alterations in pathways such as cytokine–cytokine receptor interaction and complement and coagulation cascades. RCC tissues showed significant alterations in the neuroactive ligand–receptor interaction pathway. Immune deconvolution analysis showed enhanced infiltration of macrophages in high FAI tumor tissues with a lower angiogenesis level. We also observed synchronous dynamic changes in FAI and tumor size after targeted therapy.ConclusionIn summary, FAI could be used in RCC to reflect the biological characteristics and tumor immune micro-environment of both the tumor and the peri-tumor adipose. High peri-tumor FAI had the potential to predict a worse survival outcome in various cohorts. This study demonstrates that the crosstalk exists between a tumor and its micro-environment and could be reflected easily by imaging procedures, which could facilitate clinical decision making.

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Section: Discussionmentioning

confidence: 99%

Fat Attenuation Index of Renal Cell Carcinoma Reveals Biological Characteristics and Survival Outcome

Wang

Yu²,

Hu³

et al. 2022

Front. Oncol.

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“…Regardless of tumour size, tumours can be staged as pT3a due to renal vein invasion, renal sinus invasion, or extracapsular extension, which may be microscopic and, thus, not readily appreciated on preoperative CT examination 5 , 27 , 28 . In this study, we evaluated metabolic parameters including SUV max and MTV on 18 F-FDG PET/CT and clinicopathological factors to predict extended pT stages.…”

Section: Discussionmentioning

confidence: 99%

Metabolic tumour volume on 18F-FDG PET/CT predicts extended pathological T stages in patients with renal cell carcinoma at staging

Kim

Lee

et al. 2021

Sci Rep

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We evaluated the predictive value of 18F-fluorodeoxyglucose (FDG) uptake on positron emission tomography/CT (PET/CT) for extended pathological T (pT) stages (≥ pT3a) in Renal cell carcinoma (RCC) patients at staging. Thirty-eight RCC patients who underwent 18F-FDG PET/CT at staging, followed by radical nephrectomy between September 2016 and September 2018, were included in this prospective study. Patients were classified into two groups (limited pT stage: stage T1/2, n = 17; extended pT stage: T3/4, n = 21). Univariate and multivariate logistic regression analyses were performed to identify clinicopathological and metabolic variables to predict extended pT stages. 18F-FDG metabolic parameters were compared in relation to International Society of Urological Pathology (ISUP) grade and lymphovascular invasion (LVI). In univariate analysis, maximum standardised uptake value, metabolic tumour volume (MTV), and ISUP grade were significant. In multivariate analysis, MTV was the only significant factor of extended pT stages. With a cut-off MTV of 21.2, an area under the curve was 0.944, which was higher than 0.824 for clinical T stages (p = 0.037). In addition, high MTV, but not tumour size, was significantly correlated with aggressive pathologic features (ISUP grade and LVI). High glycolytic tumour volume on 18F-FDG PET/CT in RCC patients at staging is predictive of extended pT stages which could aid decision-making regarding the best type of surgery.

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“…Tumor size, fat infiltration with a nodular appearance, and an irregular tumor margin were predictors for PNI [ 20 ]. Whereas Landman et al found that perinephric soft-tissue standing was shown to be the only significant factor for predicting PNI in tumors 4 cm or less [ 21 ]. Using the same analysis methods as for RSI, we identified independent risk factors for PNI as follows: tumor larger than 5 cm, an irregular tumor- perinephric fat border, and a tumor necrosis.…”

Section: Discussionmentioning

confidence: 99%

Factors associated with postoperative renal sinus invasion and perinephric fat invasion in renal cell cancer: treatment planning implications

et al. 2017

Oncotarget

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In patients with renal cell carcinoma (RCC), postoperative upstaging including perinephric fat invasion (PNI) and renal sinus invasion (RSI) leads to unfavorable oncological outcomes. Determining the preoperative risk factors for postoperative upstaging could be beneficial for treatment planning. In this study, 267 RCC patients who underwent radical nephrectomy were studied retrospectively. The RSI incidence was significantly greater than that of PNI. Kaplan-Meier analysis revealed that patients with RSI, PNI, and RSI plus PNI had poorer disease-free-survival than those with neither RSI nor PNI. Univariate and multivariate logistic regression analyses indicated that a tumor extension into the sinus, an irregular tumor-sinus border, and an irregular tumor shape in CT/MRI imaging were independent risk factors for RSI. And a tumor larger than 5 cm, an irregular tumor-perinephric fat border, and a tumor necrosis were independent risk factors for PNI. Subgrouping of patients into low-, moderate-, and high-risk groups according to these factors, revealed a direct association between the risk factors and PNI/RSI incidence. In conclusion, in patients with RCC, preoperative risk factors associated with postoperative upstaging could be assessed by imaging data obtained using CT or MRI. Preoperative Risk group classification would be clinically useful for patient counseling and treatment planning.

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Preoperative Computed Tomography Assessment for Perinephric Fat Invasion: Comparison With Pathological Staging

Abstract: Computed tomography does not seem to reliably predict PNF invasion. However, PN soft-tissue stranding was shown to be the only significant factor for predicting PNF invasion, which showed good accuracy with high sensitivity and high specificity in tumors 4 cm or less.

Cited by 12 publications

References 16 publications

Fat Attenuation Index of Renal Cell Carcinoma Reveals Biological Characteristics and Survival Outcome

Fat Attenuation Index of Renal Cell Carcinoma Reveals Biological Characteristics and Survival Outcome

Metabolic tumour volume on 18F-FDG PET/CT predicts extended pathological T stages in patients with renal cell carcinoma at staging

Factors associated with postoperative renal sinus invasion and perinephric fat invasion in renal cell cancer: treatment planning implications

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