| Objective:Obesity is a clear risk factor for renal cell carcinoma(RCC)and is associated with the pathological Subtypes of RCC.However,there is literature that the visceral fat is significantly different from other parts of the fat endocrine function,and may be more significantly related to clear cell RCC(ccRCC).renal minimal fat angiomyolipoma(RMFAML)has very few fat components and is difficult to differentiate from renal cell carcinoma,especially renal clear cell carcinoma(ccRCC);if misdiagnosis occurs,it may lead to unnecessary surgery.Our study aimed to demonstrate that visceral fat area(VFA)is superior to BMI in the identification of renal clear cell carcinoma and non-elear cell carcinoma(non-ccRCC)/RMFAML.Methods:The clinical data of 218 patients with renal tumor admitted to our hospital from 2016 to 2019 were retrospectively analyzed.According to the patient's postoperative pathological results,the patients were divided into two groups of control studies,ccRCC and non-ccRCC,ccRCC and RMFAML.Umbilical horizontal CT imaging data were extracted,and the visceral fat area(VFA),subcutaneous fat area(SFA)and total fat area(TFA)were measured by Image J software.Univariate and multivariate logistic regression analyses were used to compare the possible differences in clinical data between ccRCC and non-ccRCC and ccRCC and RMFAML patients,respectively.The area under the curve(AUC)of the two groups of control related indicators was compared using the ROC curve to obtain the most valuable predictor of ccRCC in the two comparisons.Results:A total of 218 patients were included in the study,including 160 patients with ccRCC,35 patients with non-ccRCC and 23 patients with RMFAML.The age[(59.19±12.32)years old and(54.40±14.39)years old],diabetes[24.38%(39/160)and 8.57%(3/35)],BMI[(24.61±2.76)kg/m2 and(22.77±2.73)kg/m2],VFA[(254.04±86.26)cm2 and(202.68±67.21)cm2]and TFA[(254.04±86.26)cm2 and(202.68±67.21)cm2]of the patients in the ccRCC and non-ccrcc control studies were statistically significant.Multivariate Logistic regression analysis showed that BMI,TFA and VFAwere independent predictors of ccRCC.According to ROC curve,AUC of VFA TFA and BMI were 0.725,0.673 and 0.677,respectively.The AUC value of VFA is the largest,and the optimal threshold is 96.232cm2,with sensitivity and specificity of 65.31%and 72.73%,respectively.The age[(59.19± 12.32)years old and(54.40±14.39)years old],gender(male)[68.75%(110/160)and 21.74%(5/23)],hypertension[48.75%(78/160)and 21.74%(5/23)],BMI[(24.61±2.76)kg/m2 and(21.34±2.94)kg/m2],SFA[(138.62±53.78)cm2and(109.95±58.47)cm2],VFA[(118.98±46.22)cm2 and(42.18±33.80)cm2]and TFA[(254.04±86.26)cm2 and(152.12±85.86)cm2]of patients in the ccRCC group and RMFAML group were statistically significant.Multivariate logistic regression analysis showed that age,gender,BMI,SFA,VFA and TFA were risk factors for the differential diagnosis of renal clear cell carcinoma and RMFAML.According to ROC curve,AUC of BMI?TFA?VFA and SFA were 0.819?0.811?0.914 and 0.679,respectively.The AUC value of VFA is the largest,and the optimal threshold is 69.99cm2,the sensitivity and specificity of ccRCC and RMFAML are 85.71%and 86.36%,respectively.Conclusion:1.In the comparison of ccRCC and non-ccRCC,high VFA,TFA and BMI were risk factors for ccRCC,and VFA had the strongest ability to identify ccRCC and non-ccRCC.2.In the comparison of ccRCC and RMFAML,high BMI,TFA,SFA and VFA are risk factors for ccRCC.Among them,VFA is also the most powerful indicator. |
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