The Role Of Tumor Size And Hematological Parameters In Predicting WHO/ISUP Grade Of Clear Cell Renal Cell Carcinoma

Background and objective:In 2016,the World Health Organization recommended the World Health Organization/International Society of Urological Pathology(WHO/ISUP)grading system as a new pathological grading standard for renal cell carcinoma,which has better accuracy and repeatability than Fuhrman grading system.Many studies have confirmed the predictive role of clinical data such as imaging data and hematological data in Fuhrman grading system.However,due to the short application time of WHO/ISUP grading system,there are relatively few studies related to it.In this study,the long diameter and the product of the long diameter and short diameter of the tumor specimen,the long diameter and the product of the long diameter and short diameter of the tumor in ultrasound were used to represent the tumor size and explore the relationship between them and WHO/ISUP grade.The predictive effect of some preoperative hematological parameters and demographic data on pathological grade was also studied,in order to provide help for the establishment of non-invasive pathological grading evaluation.Materials and methods:The clinical data of 296 patients diagnosed with clear cell renal cell carcinoma in Shandong Provincial Hospital from June 2020 to October 2021 were collected.The clinical data included basic demographic data,pathological information,ultrasound imaging information,and some hematological parameters.Kruskal-Wallis test,one-way analysis of variance,and Fisher’s precision probability test were used to compare the clinical data among the four WHO/ISUP grades.Then the patients were divided into the high-grade group and the low-grade group.Mann-Whitney U test,independent sample t-test,and Pearson chi-square test were used to compare the differences in clinical data between the low-grade group and the high-grade group.Univariate and multivariate Logistic regression analyses were used to determine factors that could predict WHO/ISUP grade,and then the receiver operating characteristic curve was used to evaluate their predictive efficacy for WHO/ISUP grade,and the Delong test was used to compare the predictive efficacy.Research results:Univariate Logistic regression analysis showed that gender,long diameter of the specimen,systemic immune inflammation index,hemoglobin,calcium,C-reactive protein,and albumin had statistical significance in differentiating four grades,while in multivariate Logistic regression analysis,only the long diameter of the specimen(OR=1.292,95%CI=1.134-1.472,P<0.001)and gender(OR=4.095，95%CI=2.001-8.379,P<0.001)were independent predictors of pathological grade.In univariate Logistic regression analysis,gender,long diameter of the specimen,systemic immune inflammation index,red blood cell,hemoglobin,monocyte absolute value,calcium,C-reactive protein,albumin,cholesterol,low-density lipoprotein cholesterol were statistically significant in differentiating low-grade and high-grade,but only long diameter of the specimen(OR=1.393,95%CI=1.173-1.654,P<0.001)and gender(OR=12.754,95%CI=2.616-62.176,P=0.002)were statistically significant in multivariate Logistic regression analysis.The adjusted OR values of the product of the long diameter and short diameter of the tumor specimen,the long diameter and the product of the long diameter and short diameter of the tumor in ultrasound in distinguishing WHO/ISUP grades were respectively 1.017(95%CI=1.006-1.028,P=0.003),1.262(95%CI=1.120-1.425,P=0.003),and 1.019(95%CI=1.006-1.031,P=0.004),and the adjusted OR values in binary Logistic regression analysis in differentiating low-grade and high-grade were respectively 1.024(95%CI=1.009-1.040,P=0.002),1.353(95%CI=1.143-1.601,P=0.000)and 1.026(95%CI=1.009-1.044,P=0.002).The receiver operating characteristic curve of the predictive ability of tumor size in differentiating low-grade and high-grade showed that the area under the curve of the long diameter and the product of the long diameter and short diameter of the tumor specimen,the long diameter and the product of the long diameter and short diameter of the tumor in ultrasound were respectively 0.714,0.731,0.704 and 0.697,and there were no significant differences.Research conclusions:Tumor size is an independent predictor of the WHO/ISUP grading system,and the larger the tumor,the higher the risk of high grade.The efficacy of the long diameter and the product of the long diameter and short diameter in predicting pathological grade is similar,and the efficacy of ultrasound tumor size and specimen tumor size in predicting pathological grade is also similar.Gender is also related to the pathological grade,and male patients have a greater risk of high grade than female patients.When the WHO/ISUP grading system was simplified to a two-level system of high grade and low grade,tumor size and gender had a better correlation with pathological grade.