Analysis Of Predictors Of The Pathological Properties Of Endophytic Renal Tumor

Background and Objective:In recent years,the detection rate of renal tumors in clinical work has increased greatly,while most of the lesions found in health examination were small renal tumors,including a very few endophytic tumors with special locations.Due to the high complexity of anatomical structure and the high difficulty and high risk of surgical treatment,it has attracted the attention of urology experts and scholars at home and abroad.Its treatment options include surgical treatment(including radical nephrectomy and nephron sparing surgery)minimally invasive treatment(including radiofrequency ablation,cryoablation,microwave ablation,etc.)and active surveillance.This study explored the influencing factors of the pathological properties of endophytic renal tumor,and to provide relevant oncopathology information for clinicians to make treatment plans for patients with endophytic renal tumors.Methods:A retrospective study was conducted on the relevant clinical data(including basic data,imaging data and pathological data)of patients with endophytic renal tumor from August 1,2016 to December 31,2020 in the Department of Urology,The First Affiliated Hospital of Nanchang University.The patients were divided into benign group and malignant group(low grade group and high grade group)according to the pathological data.Chi-square test and Student t test were used to analyze the differences of basic data and tumor anatomical data between groups.Univariate binary Logistic regression analysis was conducted to analyze the basic characteristics(sex,age,BMI,tumor size,left or right side)and individual components of the R.E.N.A.L.Nephrometry Score and the nephrometry sum was correlated with the malignant and high-grade properties of endophytic renal tumors.Then multivariate binary Logistic regression analysis was conducted to determine independent risk factors.Then a score scale was constructed to predict the pathological properties of tumors according to independent risk factors.Finally,the ROC curves were constructed to evaluate the efficacy of risk factors in predicting tumor pathological properties.Results:A total of 72 cases of endophytic renal tumors were analyzed.Chi-square test and Student t test showed that there were significant differences in sex,“N” and “L”single score and the nephrometry sum of RENAL-NS between the benign group and the malignant group(P<0.05),and the proportion of males,the proportion of high scores in “N” and “L” single score and the nephrometry sum of RENAL-NS in the malignant group ware significantly higher than that of the benign group.Comparing the basic data and clinical data of the lower and higher grade groups,it was found that advanced age was associated with higher grade tumors(P<0.05).Univariate and multivariate binary Logistic regression analysis showed that males,tumors near to the renal sinus or collection system(≦4mm)and closely related to the polar line(>50%crosses polar line,crosses renal line,within polar line)were independent risk factors for endophytic malignant renal tumor(P<0.05).The S.N.L.rating scale was constructed based on independent risk factors,and receiver operating characteristic(ROC)curve was constructed according to the score.The S.N.L.rating scale was highly effective in predicting the pathological properties of endophytic renal tumors(AUC>0.8).And the sensitivity and specificity were 0.917 and 0.667 for malignant tumor with S.N.L.score above 4.In the low-grade and high-grade groups,only age was found as a relevant variable(P<0.1).In addition,there were few cases in the high grade group,so multivariate Logistic regression analysis and ROC curve were not performed.Conclusion:The R.E.N.A.L.Nephrometry Score is feasible to predict the biological information of endophytic renal tumors.Malignancy occur with much greater frequency when tumors are occur in male,in close proximity to the renal nius or collecting system(<4 mm)and closely related to the polar line(>50% crosses polar line,crosses renal line,within polar line).In addition,advanced age may be associated with high-grade tumor.The S.N.L.rating scale constructed by independent risk factors was highly effective in predicting the pathological properties of endophytic renal tumors.And it can provide valuable oncopathology information for clinicians to make treatment plans for patients with endophytic renal tumors.Its universality and practicality need to be further confirmed by further studies.