A preoperative nomogram predicting the pseudocapsule status in localized renal cell carcinoma

Area of Science:

• Urology
• Oncology
• Radiology

Background:

• Renal cell carcinoma (RCC) tumor enucleation (TE) surgery requires an intact peritumoral pseudocapsule (PC).
• Accurate preoperative assessment of PC status is crucial for successful TE surgery.

Purpose of the Study:

• To develop and validate a predictive model for preoperative assessment of PC status in localized RCC.
• To identify key factors influencing PC invasion for improved surgical planning.

Main Methods:

• A cohort of 170 localized RCC patients (2010-2015) was analyzed.
• Multivariable logistic regression and R software were used to build the prediction model.
• Model performance was evaluated using calibration, discrimination (C-index), sensitivity, and specificity.

Main Results:

• The model integrated systemic inflammatory markers (neutrophil-lymphocyte ratio, albumin-globulin ratio), CT features (tumor size, necrosis), and BMI.
• The model demonstrated strong discrimination (C-index: 0.85) and good calibration (P=0.60).
• High sensitivity (62%) and specificity (94%) were achieved, with demonstrated clinical usefulness.

Conclusions:

• A novel preoperative model combining inflammatory markers and clinical factors accurately predicts PC invasion risk.
• This model aids in identifying optimal candidates for TE surgery in localized RCC.
• Facilitates individualized risk assessment and enhances surgical decision-making for RCC patients.