Presence of Intratumoral Calcifications and Vasculature Is Associated With Poor Overall Survival in Clear Cell Renal Cell Carcinoma

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Abstract
Purpose: The objective of this study was to explore the prognostic significance of the preoperative computed tomography (CT) features in clear cell renal cell carcinoma. Patients and Methods: The clinical data and CT data from 210 patients (1 grade 1, 84 grade 2, 92 grade 3, and 32 grade 4) generated with The Cancer Imaging Archive were reviewed. Overall survival was assessed using Kaplan-Meyer analysis. The relationship between CT features and survivals were evaluated using univariate and multivariable Cox regression analysis. Results: The follow-up occurred between 13 and 3989 days (median, 1405 days; mean, 1434 days).On univariate Cox regressions, 4 preoperative CT features (intratumoral calcifications: yes vs no hazard ratio [HR], 2.054; 95% confidence interval [CI], 1.231–3.428; renal vein invasion: yes vs no HR, 2.013; 95% CI, 1.218–3.328; collecting system invasion: yes vs no HR, 2.139; 95% CI, 1.286–3.558; gross appearance of intratumoral vasculature: yes vs no HR, 2.385; 95% CI, 1.454–3.915) were significantly associated with overall survival (all P < 0.05). On multivariable Cox regression analysis, predictors of mortality in clear cell renal cell carcinoma were the presence of intratumoral calcifications (HR, 1.718; 95% CI, 1.014–2.911; P = 0.044) and gross appearance of intratumoral vasculature (HR, 2.137; 95% CI, 1.284–3.557; P = 0.003). Conclusions: Presence of intratumoral calcifications and vasculature can be potential prognostic features to screen patients for unfavorable prognosis.

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