title: Clear Cell Renal Cell Carcinoma: Associations Between CT Features and Patient Survival.
abstract: OBJECTIVE
  The objective of this study was to investigate associations between CT features and survival in patients with clear cell renal cell carcinoma (ccRCC).
  
  
  METHODS
  The study included 763 patients with histopathologically confirmed ccRCC who underwent preoperative contrast-enhanced CT between 1999 and 2011. Imaging features, both qualitative (cystic tumor, necrosis, tumor contact with renal sinus, renal vein invasion, peritumoral stranding, and peritumoral neovascularity) and quantitative (maximal tumor diameter and distance from the tumor to the renal sinus), were evaluated. Univariate and multivariable Cox regressions were used to assess associations of imaging features with disease-specific survival (DSS) and disease-specific progression-free survival (PFS).
  
  
  RESULTS
  Greater tumor size and the presence of renal vein invasion on CT were associated with decreased DSS and disease-specific PFS (p < 0.05), and the presence of extensive necrosis (more than two-thirds of the tumor volume) was associated with decreased disease-specific PFS (p < 0.05); this association remained statistically significant when we controlled for pathologic tumor stage. In contrast, no disease-specific death or progression was seen in patients with purely cystic tumors. Greater distance between the tumor and the renal sinus was not statistically significantly associated with longer survival.
  
  
  CONCLUSIONS
  In patients with ccRCC, observation of extensive necrosis on CT was statistically significantly associated with decreased disease-specific PFS, whereas greater tumor size and the presence of renal vein invasion on CT were statistically significantly associated with decreased DSS and disease-specific PFS. No disease progression was observed in tumors with a cystic appearance. Therefore, selected CT features could potentially aid in risk assessment for and counseling of patients with ccRCC and could provide prognostic information beyond the established tumor staging system.
authors.affiliation: 1 Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065.|2 Department of Diagnostic and Interventional Radiology, Universitätsmedizin Mainz, Mainz, Germany.
authors.forename: Andreas M
authors.initials: AM
authors.lastname: Hötker
authors.affiliation: 1 Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065.
authors.forename: Christoph A
authors.initials: CA
authors.lastname: Karlo
authors.affiliation: 3 Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY.
authors.forename: Junting
authors.initials: J
authors.lastname: Zheng
authors.affiliation: 3 Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY.
authors.forename: Chaya S
authors.initials: CS
authors.lastname: Moskowitz
authors.affiliation: 4 Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY.
authors.forename: Paul
authors.initials: P
authors.lastname: Russo
authors.affiliation: 1 Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065.
authors.forename: Hedvig
authors.initials: H
authors.lastname: Hricak
authors.affiliation: 1 Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065.
authors.forename: Oguz
authors.initials: O
authors.lastname: Akin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000000981:diagnostic imaging* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D018570:Risk Assessment; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D055815:Young Adult
keywords: CT; diagnostic imaging; outcome assessment; renal cell carcinoma