MSCT征象术前预测透明细胞肾细胞癌WHO/ISUP病理分级的可行性研究

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中图分类号：R737.11 文献标志码：A DOI：10.3969/j.issn.1003-1383.2025.12.008

【Abstract】ObjectiveTo explore the valueof multi-slice spiral CT（MSCT）in predicting WHO/ISUPpathological grade of clearcellrenalcellcarcinoma （ccRCC）beforeoperation.Methods68 patientswithcRCC diagnosed byhistopathology afteroperation wereretrospectivelycolected.Allpatientsunderwentabdominal CTplainscanplusthree-phase enhancedscan before operation.Acording to WHO/ISUPclasification，GradeIand I were included inlow grade group（49 patients）， Grade Il and IV were included in high grade group（19 patients）. The general clinical data and MSCT signs of the two groups of patients werecollectedandcompared.Logsticregressonwasused toanalyzetheinfluencingfactorsof diffrent WHO/ISUP grades of ccRCC，andROC curves were drawn toevaluate thediagnostic eficacyof thetwo groups indiagnosing WHO/ISUP grades ofcRCC.ResultsThere were statistically significant diferences inrelated clinical symptoms，maximum diameter， morphology，lobulationsign，renalsinusinvasion，intratumoralarteryandperitumoralveinbetweenhighandlowgradecRCC patients （ P<0.05 ）.Logistic regression results showed that intratumoral artery and peritumoral vein were independent predictive indicators. ROC curves showed that the AUC of combined model for predicting ccRCC WHO/ISUP grade（O.897）was higherthanthatofsingleindex（the AUC ofintratumoral arteryand peritumoral veinwere O.828 and O.8O3，respectively）.ConclusionMSCTsignsarecloselyrelated to WHO/ISUPgradeofccRCC.Intratumoralarteryand peritumoralveinare independent redictorofccRCC WHO/ISUP grade.Thecombination modelof MSCTand peritumoral vein canacurately predict the pathological grade of ccRCC before operation，which can provide basis for further clinical treatment of ccRCC.

Keywords】clear cellrenal cell carcinoma （ccRCC）；WHO/ISUP clasification；multi-slice spiral CT（MSCT

肾细胞癌（renalcellcarcinoma，RCC）是肾脏最常见的恶性肿瘤，发病率呈逐年上升趋势，其最常见的病理亚型为透明细胞肾细胞癌（clearcellrenalcell carcinoma，ccRCC），占 RCC 的 70%～ 90%[1]ccRCC较其他亚型RCC恶性程度更高，世界卫生组织（worldhealthorganization，WHO）/国际泌尿病理学会（international society of urological pathology，ISUP）病理分级在2016年第四版WHO肾脏肿瘤新分类中被推荐应用于临床，并在2022年第五版WHO肾脏肿瘤新分类中明确提出了该分级系统适用范围包括ccRCC和乳头状肾细胞癌（papillaryrenalcellcarcinom，PRCC）[2]，因而也成为判定ccRCC恶性程度与患者预后的标准及重要指标，不同分级治疗方案不尽相同。（剩余6067字）