Utility Of Plasma Cystatin C And Fibrinogen As A Biomarker In Differential Diagnosis Of RCC And RAML

Purpose:This study intends to use statistical methods to study the cystatin C(Cys C)and fibrinogen(Fib)in human plasma in renal cell carcinoma(RCC)and renal angiomyolipoma(RAML)through a retrospective study.The differences between the two were used as biomarkers for the differential diagnosis of RCC and RAMLMethod:In this single-center retrospective study,our team conducted statistics on 253 patients who were diagnosed with RCC and RAML at the Shandong University Qilu Hospital from October 2014 to October 2019.All patients underwent surgical treatment.We first removed the cases that did not meet the inclusion criteria and based on metabolomics,the blood samples,basic patient conditions,and tumor basics of patients with RCC and RAML.The situation was tested and analyzed with multiple statistical data.Based on this,the receiver's working characteristic curve(ROC curve)was used to determine the plasma Cys C and Fib levels of patients and the value of combined Cys C and Fib in the differential diagnosis of RCC and RAML.Perform statistical analysis,and use logistic regression(Logistic regression)model to verify the potential diagnostic value of plasma Cys C level and Fib level in the differential diagnosis of RCC and RAML under the influence of single factor and multiple factors.Finally,the Mann-Whitney U test was used to compare the results in RCC.The values of plasma cystatin C and plasma fibrinogen corresponding to different Furhman classifications and their significanceResult:1.Analysis of basic information and blood samples of patients with renal clear cell carcinoma and renal hamartoma using the Mann-Whitney U test found that the average Cys C(RCC vsRAML:1.04 ± 0.78 mg/L:0.81±0.16)of RCC patients before surgery mg/L,P<0.001)and Fib(RCC:RAML:3.55 ± 1.22g/L:2.99 ±0.76g/L,P<0.001)were significantly higher than RAML;in addition,the patient's age and other data in blood samples such as:The differences between NLR,PLR and WBC between ccRCC and RAML were statistically significant.2.Use the receiver operator characteristic curve(ROC curve)to calculate the area under the curve(AUC),and then according to the most approximate index(Yordon index=sensitivity+specificity-1)Determine the best diagnostic cut-point value,evaluate the diagnostic efficacy of each value to find Fib;ROC curves of Cys C and combined Fib,Cys C,the area under the curve is 0.64(95%CI 0.571-0.709,P<0.001);0.685(95%CI0.681-0.751,P<0.001);0.700(95%CI0.635-0.765),with the largest Youden index,the Cys C value of RCC and RAML is 0.885mg/L;the Fib value is 3.410g/L.The specificity of Fib in differential diagnosis was 81.4%;the sensitivity was 44.8%;the specificity of Cys C was 76.5%;the sensitivity was 53.8%The specificity of the combined diagnosis of Fib and Cys C was 84.3%;the sensitivity was 51.4%3.Use logistic regression analysis to further evaluate the significance of Cys C,Fib,age,WBC,NLR,and tumor size in the differential diagnosis of RCC and RAML.Cys C and Fib are significantly related to the differential diagnosis of RCC and RAML(Cys C:HR?3.742),P<0.05;Fib:HR?3.584,P<0.05),and found that the differential diagnosis of RCC and RAML by age,WBC,NLR did not provide too effective evidence(age:HR?1.075,P<0.05;WBC:HR?1.183,P 0.033;NLR:HR?1.360,P<0.05),tumor size was not related to differential diagnosis of RCC and RAML.Multivariate analysis found that Cys C and Fib were significantly related to the differential diagnosis of RCC and RAML(Cys C:HR=2.36,P<0.05;Fib:HR?2.345,P<0.05)4.In the ccRCC study cohort,the ccRCC patients were divided into three groups according to the pathological nuclear classification of the patients.Statistical analysis of the preoperative plasma Fib and Cys C concentrations of patients revealed that the plasma concentration of Fib increased with the increase of Furhman classification(Fib:Grade? 2.95+-0.39g/L,grade? 3.42+-1.06g/L,grade? 3.72+-1.29g/L);Cys C plasma concentration decreases as Furhman grade increases(Cys C:grade?1.09+-1.32mg/L,grade? 1.05+-0.9mg/L,grade? 0.97+-0.26mg/L),although P>0.05 is not statistically significant,but the trend is obvious and it has value for later researchConclusion:In this paper,the data of patients with renal cell carcinoma and renal vascular smooth muscle lipoma were collected and screened strictly.Through u test,ROC curve,logistic regression analysis,it was found that the plasma concentration levels of Cys C and Fib before surgery were statistically significant for the differential diagnosis of RCC and RAML.The combined use of plasma Cys C and Fib had higher diagnostic efficacy and could be more stable.Provide diagnostic basis,therefore,we believe that changes in plasma concentrations of Cys C and Fib before surgery can provide a new basis and methods for the differential diagnosis of RCC and RAML.