Abstract:

Objective

To investigate the relationship between preoperative inflammatory indicators and the WHO/ISUP pathological grading of clear cell renal cell carcinoma， and to construct a predictive model.

Methods

The data of clear cell renal cell carcinoma patients who underwent surgical treatment in the Urology Department of the First Affiliated Hospital of Soochow University from January 2018 to December 2019 were analyzed retrospectively.According to the WHO/ISUP pathological grading system， 153 patients were divided into a low-grade group （grade I， II） and a high-grade group （grade III，IV）， and the differences in clinical and pathological parameters between the two groups were compared.Multivariate logistic analyses were used to identify independent risk factors for predicting pathological grading， and a nomogram predictive model was constructed and evaluated using a calibration curve.Lastly，the diagnostic efficacy of the model was tested using receiver operating characteristic （ROC） curves and decision curve analysis （DCA） was used to evaluate the net benefits of the model.

Results

There were significant differences between the low-grade and high-grade groups in tumor diameter， neutrophil-tolymphocyte ratio （NLR）， platelet-to-lymphocyte ratio （PLR）， lymphocyte-to-monocyte ratio （LMR）， and systemic immune inflammation index （SII） （P＜0.05）.Multivariate logistic analyses revealed that tumor diameter （OR=1.026， 95%CI： 1.003-1.050）， NLR （OR=3.725， 95%CI： 1.818-7.630）， and PLR （OR=1.021，95%CI： 1.008-1.035） were independent risk factors for predicting the pathological high grading of clear cell renal cell carcinoma （P＜0.05）.A predictive model was constructed using the multivariate logistic model and the calibration curve， which demonstrated good predictive accuracy （χ²=12.853， P=0.117）.The ROC curve results suggested that the predictive model had the highest area under the curve （AUC）value （0.809）， which was significantly higher than that of the single diagnostic parameters including tumor diameter， NLR， and PLR （P＜0.05）.The DCA presented higher clinical net benefits for the predictive model as compared to other indicators.

Conclusions

The tumor diameter， NLR， and PLR are related to the WHO/ISUP pathological grading of clear cell renal cell carcinoma， and the constructed predictive model has strong diagnostic efficacy.

Key words: Inflammatory indicators, Clear cell renal cell carcinoma, Predictive model, Pathological grading