The Potential of Visceral Adipose Tissue in Distinguishing Clear Cell Renal Cell Carcinoma from Renal Angiomyolipoma with Minimal Fat

Abstract

Jianhu Liu,1,2,* Jie Bao,3,* Weijie Zhang,1 Qiaoxing Li,2 Jianquan Hou,1 Xuedong Wei,1 Yuhua Huang1 1Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, People’s Republic of China; 2Department of Urology, Affiliated Kunshan Hospital of Jiangsu University, Suzhou, 215300, People’s Republic of China; 3Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, People’s Republic of China*These authors contributed equally to this workCorrespondence: Xuedong WeiDepartment of Urology, The First Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou, Jiangsu, 215006, People’s Republic of ChinaTel [phone]Fax [phone]Email [email protected] HuangDepartment of Urology, The First Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou, Jiangsu, 215006, People’s Republic of ChinaTel [phone]Fax [phone]Email [email protected]: To overcome the challenge of preoperative differentiation between clear cell renal cell carcinoma (ccRCC) and renal angiomyolipoma with minimal fat (RMFAML), we evaluated the potential of visceral adipose tissue (VAT) in distinguishing RMFAML from ccRCC.Patients and Methods: Patients (191) were divided into ccRCC and RMFAML groups according to postoperative pathology. Umbilical horizontal computed tomography (CT) images were used for visceral fat area (VFA), subcutaneous fat area (SFA) and total fat area (TFA) measurements. Logistic regression was used to identify risk factors for ccRCC. Areas under the receiver operating characteristic (ROC) curve (AUCs) were compared to identify the most valuable indicator for identifying ccRCC and RMFAML.Results: In total, 166 patients had ccRCC, and 25 had RMFAML. ccRCC and RMFAML patients showed significant differences in age (P< 0.001), sex (P< 0.001), hypertension (P=0.027), BMI (P< 0.001), SFA (P=0.046), VFA (P< 0.001) and TFA (P< 0.001). According to multiple logistic regression analysis, male sex [4.311 (1.469∼ 12.653), p=0.008]; older age [1.047 (1.008∼ 1.088), p=0.017]; and higher BMI [1.305 (1.088∼ 1.566), p=0.004], SFA [1.013 (1.003∼ 1.023), p=0.008], VFA [1.026 (1.012∼ 1.041), p< 0.001] and TFA [1.011 (1.005∼ 1.017), p=0.001] were associated with ccRCC. The AUCs of sex (male), age, BMI, TFA, VFA, and SFA were 0.726, 0.687, 0.783, 0.769, 0.840, and 0.645, respectively. The VFA cut-off value was 69.99 cm2. The sensitivity and specificity of higher VFA (≥ 69.99 cm2) for ccRCC diagnosis were 79.52% and 80.00%, respectively.Conclusion: In differentiating ccRCC from RMFAML, male sex, older age, and higher BMI, TFA, SFA, and VFA are risk factors for ccRCC. VFA is the most effective indicator for identifying ccRCC.Keywords: body mass index, clear cell renal cell carcinoma, obesity-related index, renal angiomyolipoma with minimal fat, visceral adipose tissue, visceral fat area

Keywords

• body mass index
• clear cell renal cell carcinoma
• obesity-related index
• renal angiomyolipoma with minimal fat
• visceral adipose tissue
• visceral fat area