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- Title
Should We Always Perform Preoperative Chest Computed Tomography in Patients with cT1a Renal Cell Carcinoma?
- Authors
Chung, Jae-Wook; Kang, Jun-Koo; Jang, Se Won; Lee, Eun Hye; Chun, So Young; Choi, Seock Hwan; Lee, Jun Nyung; Kim, Bum Soo; Kim, Hyun Tae; Kim, See Hyung; Kim, Tae-Hwan; Yoo, Eun Sang; Kwon, Tae Gyun; Park, Dong Jin; Ha, Yun-Sok
- Abstract
Simple Summary: We aimed to establish an objective standard for optimal timing of preoperative chest computed tomography (CT) in patients with renal cell carcinoma (RCC). 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), Charlson comorbidity index (CCI) ≥4, and low albumin/globulin ratio (AGR) were associated with a higher risk of positive chest CT scans. 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 was 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. 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.
- Subjects
RENAL cell carcinoma; PREOPERATIVE care; CHEST X rays; MULTIPLE regression analysis; CANCER patients; SERUM albumin; DESCRIPTIVE statistics; COMPUTED tomography; DECISION making in clinical medicine; DIAGNOSTIC errors; COMORBIDITY
- Publication
Cancers, 2022, Vol 14, Issue 22, p5558
- ISSN
2072-6694
- Publication type
Article
- DOI
10.3390/cancers14225558