肾透明细胞癌WHO/ISUP分级的超声预测因素分析

目的探讨肾透明细胞癌（CCRCC）WHO/ISUP病理分级的超声预测因素。 方法回顾性选取浙江省人民医院2017年1月至2020年11月经手术病理证实的CCRCC患者87例，所有患者术前均行常规超声及超声造影（CEUS）检查。依据WHO/ISUP病理分级将患者分为低级别组（1、2级）和高级别组（3、4级）。单因素分析比较2组患者的常规超声和CEUS特征，然后采用Logistic多因素回归方法分析CCRCC患者WHO/ISUP病理分级的超声预测因素，得出回归方程，并计算回归模型的ROC曲线下面积。 结果87例CCRCC中WHO/ISUP分级1级19例（21.8%），2级47例（54.0%），3级18例（20.8%），4级3例（3.4%）。依据病理结果，将87例患者分为低级别组66例，高级别组21例。单因素分析显示，低级别组与高级别组的肿瘤平均直径、CEUS增强均匀性、非增强区比值比较，差异均有统计学意义（瘤体平均直径：Z=-2.326，P=0.020；CEUS增强均匀性：χ²=5.165，P=0.023；非增强区比值：χ²=12.167，P＜0.001）。Logistic多因素回归分析显示，肿瘤平均直径（OR=1.047，95%CI：1.002~1.094）和非增强区比值≥50%（OR=3.951，95%CI：1.279~14.489）是WHO/ISUP肾肿瘤分级的独立预测因素。得出Logistic回归方程为：Logistic（P）=-3.322+1.047X₄+3.951X₁₁，其ROC曲线下面积为0.824（95%CI：0.726~0.921）。 结论肿瘤直径越大、CEUS非增强区比值≥50%倾向于高级别CCRCC。应用常规超声和CEUS检查有助于术前预测CCRCC的WHO/ISUP分级，进而可为临床治疗方案的选择提供参考依据。

Ultrasonic predictors of WHO/ISUP classification of clear cell renal cell carcinoma

ObjectiveTo identify the ultrasonic predictors of clear cell renal cell carcinoma (CCRCC) and pathological WHO/ISUP classification. MethodsEighty-seven patients with CCRCC confirmed by surgical pathology from January 2017 to November 2020 were selected retrospectively. All patients were examined by conventional ultrasound and CEUS before operation. According to WHO/ISUP pathological classification, the patients were divided into low-grade group (grades 1 and 2) and high-grade group (grades 3 and 4). Single factor analysis were used to compare the characteristics of conventional ultrasound and CEUS in the two groups, and the ultrasonic predictive factors of WHO/ISUP pathological classification of CCRCC patients were identified by logistic multivariate regression method. The regression equation was obtained and the area under the ROC curve of regression model was calculated. ResultsAmong the 87 CCRCC cases, 19 (21.8%) were grade 1, 47 (54.0%) were grade 2, 18 (20.8%) were grade 3, and 3 (3.4%) were grade 4. Based on the pathological findings, the 87 patients were divided into the low-grade group with 66 patients and the high-grade group with 21 patients. Univariate analysis showed that there were significant differences between the low-grade and high-grade groups in the mean diameter of the tumor, CEUS contrast-enhanced uniformity, and non-enhancing area ratio (mean diameter of the tumor: Z=-2.326, P=0.020; CEUS enhancement uniformity: χ²=5.165, P=0.023; non-enhancing area ratio: χ²=12.167, P＜0.001). Logistic multivariate regression analysis showed that mean tumor diameter (OR=1.047, 95% CI: 1.002-1.094) and non-enhancing area ratio (OR=3.951, 95% CI: 1.279-14.489) were independent predictors of WHO/ISUP .The logistic regression equation was derived as follows: logistic (P)=-3.322+1.047X₄+3.951X₁₁, for which the area under the ROC curve was 0.824 (95% CI: 0.726-0.921). ConclusionA larger diameter of the mass and CEUS non-enhancing area ratio ≥50% predispose to high-grade CCRCC. The application of conventional ultrasound and CEUS examination is helpful to preoperatively predict the WHO/ISUP grade of CCRCC, which in turn may provide a reference basis for the selection of clinical treatments.