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Prediction models for clear cell renal cell carcinoma ISUP/WHO grade: comparison between CT radiomics and conventional contrast-enhanced CT.

OBJECTIVES
Comparing the prediction models for the ISUP/WHO grade of clear cell renal cell carcinoma (ccRCC) based on CT radiomics and conventional contrast-enhanced CT (CECT).


METHODS
The corticomedullary Phase images of 119 cases of low-grade (I and II) and high-grade (III and IV) ccRCC based on 2016 ISUP/WHO pathological grading criteria were analyzed retrospectively. The patients were randomly divided into training and validation set by stratified sampling according to 7:3 ratio.Prediction models of ccRCC differentiation were constructed using CT radiomics and conventional CECT findings in the training setandwere validated using validation set.The discrimination, calibration, net reclassification index (NRI) and integrated discrimination improvement index (IDI) of the two prediction models were further compared.The decision curve was used to analyze the net benefit of patients under different probability thresholds of the two models.


RESULTS
In the training set, the C-statistics of radiomics prediction model was statistically higher than that of CECT (p < 0.05), with NRI of 9.52% and IDI of 21.6%, both with statistical significance (p < 0.01).In the validation set, the C-statistics of radiomics prediction model was also higher but did not show statistical significance (p = 0.07). The NRI and IDI was 14.29 and 33.7%, respectively, both statistically significant (p < 0.01). Validation setdecision curve analysis showed the net benefit improvement of CT radiomics prediction model in the range of 3-81% over CECT.


CONCLUSION
The prediction model using CT radiomics in corticomedullary phaseis more effective for ccRCC ISUP/WHO grade than conventional CECT.


ADVANCES IN KNOWLEDGE
As a non-invasive analysis method, radiomics can predict the ISUP/WHO grade of ccRCC more effectively than traditional enhanced CT.