Node-RADS score on CT imaging predicts lymph node metastasis and survival in renal cell carcinoma: A multicenter...

To evaluate the diagnostic performance of Node-RADS for assessing regional lymph node metastasis (RLNM) in renal cell carcinoma (RCC) by computed tomography (CT) and explore its prognostic value.

This retrospective study included 250 RCC patients who underwent nephrectomy and RLN dissection (2018-2024). Two radiologists independently evaluated lymph nodes using Node-RADS. Receiver operating characteristic (ROC) curves assessed predictive performance for RLNM. Inter- and intra-observer agreement was analyzed with Cohen's kappa. A nomogram integrating clinical variables and Node-RADS was constructed. Overall survival (OS) was compared between low (Node-RADS 1-3) and high (Node-RADS 4-5) score groups.

Of 250 patients, 61 had RLNM. Subtype, T category, Fuhrman grade, distant metastasis, tumor size, systemic methods, and Node-RADS differed significantly between groups (all P < 0.05). ‌AUC values for Node-RADS cutoffs‌ were as follows: ≥4 (0.88), ≥3 (0.86), ≥5 (0.83), and ≥ 2 (0.76). ‌Inter-observer agreement‌ was 0.75, and ‌intra-observer agreement‌ was 0.82 (both P < 0.001). The newly developed nomogram demonstrated superior predictive performance for RLNM status compared to Node-RADS score, T classification, and distant metastasis, with significantly higher AUC values (0.960 vs. 0.880, 0.810, and 0.700, respectively; all P < 0.001). High Node-RADS scores were associated with shorter median OS (24.2 months vs. not reached; P < 0.001).

CT-based Node-RADS shows high accuracy for RLNM prediction and provides clinically relevant prognostic information in RCC.