A Computed Tomography-Based Radiomics Nomogram to Preoperatively Predict Tumor Necrosis in Patients With Clear Cell Renal Cell Carcinoma

Objective: To develop and validate a radiomics nomogram for preoperative prediction of tumor necrosis in patients with clear cell renal cell carcinoma (ccRCC). Methods: In total, 132 patients with pathologically confirmed ccRCC in one hospital were enrolled as a training cohort, while 123 ccRCC patients from second hospital served as the independent validation cohort. Radiomic features were extracted from corticomedullary and nephrographic phase contrast-enhanced computed tomography (CT) images. A radiomics signature based on optimal features selected by consistency analysis and the least absolute shrinkage and selection operator was developed. An image features model was constructed based on independent image features according to visual assessment. By integrating the radiomics signature and independent image features, a radiomics nomograph was constructed. The predictive performance of the above models was evaluated using receiver operating characteristic (ROC) curve analysis. Furthermore, the nomogram was assessed using calibration curve and decision curve analysis. Results: Thirty-seven features were used to establish a radiomics signature, which demonstrated better predictive performance than did the image features model constructed using tumor size and intratumoral vessels in the training and validation cohorts (p <0.05). The radiomics nomogram demonstrated satisfactory discrimination in the training (area under the ROC curve [AUC] 0.93 [95% CI 0.87–0.96]) and validation (AUC 0.87 [95% CI 0.79–0.93]) cohorts and good calibration (Hosmer-Lemeshow p>0.05). Decision curve analysis verified that the radiomics nomogram had the best clinical utility compared with the other models. Conclusion: The radiomics nomogram developed in the present study is a promising tool to predict tumor necrosis and facilitate preoperative clinical decision-making for patients with ccRCC.