Should We Always Perform Preoperative Chest Computed Tomography in Patients with cT1a Renal Cell Carcinoma?
Jae Wook ChungJun-Koo KangSe Won JangEun Hye LeeSo Young ChunSeock Hwan ChoiJun Nyung LeeBum Soo KimHyun Tae KimSee Hyung KimTae-Hwan KimEun Sang YooTae Gyun KwonDong Jin ParkYun Sok HaPublished in: Cancers (2022)
No definitive criteria regarding the performance of preoperative chest computed tomography (CT) in patients with cT1a renal cell carcinoma (RCC) exists. We aimed to establish an objective standard for the optimal timing of preoperative chest CT in patients with RCC. Data from 890 patients who underwent surgical treatment for RCC between January 2011 and December 2020 were retrospectively collected. The primary endpoint was detection of lung metastasis on chest CT before nephrectomy. A multivariable logistic regression model predicting positive chest CT scans was used. Predictors included preoperative cTN stage, presence of systemic symptoms, Charlson comorbidity index (CCI), platelet count/hemoglobin ratio, albumin/globulin ratio (AGR), and De Ritis ratio. The overall rate of positive chest CT scans before nephrectomy was 3.03% (27/890). Only one patient had lung metastasis before surgery for cT1a. cT stage (≥cT1b), CCI ≥4, and low AGR were associated with a higher risk of positive chest CT scans. The best cutoff value for AGR was 1.39. After 890-sample bootstrap validation, the concordance index was 0.80. The net benefit of the proposed strategy was superior to that of the select-all and select-none strategies according to decision curve analysis. Therefore, when chest CT scans were performed with a risk of a positive result ≥10%, 532 (59.8%) negative chest CT scans could be prevented. Only 24 (2.7%) potentially positive chest CT scans were misdiagnosed. Therefore, we recommend chest CT in patients with ≥cT1b disease, CCI ≥4, and low AGR.
Keyphrases
- computed tomography
- dual energy
- contrast enhanced
- image quality
- positron emission tomography
- magnetic resonance imaging
- renal cell carcinoma
- magnetic resonance
- chronic kidney disease
- end stage renal disease
- spinal cord
- ejection fraction
- neuropathic pain
- radiation therapy
- depressive symptoms
- atrial fibrillation
- acute coronary syndrome
- robot assisted
- machine learning
- physical activity
- pet ct
- patient reported outcomes
- deep learning
- sensitive detection
- prognostic factors