A comparison of perinephric fat surface area and Mayo Adhesive Probability score in predicting malignancy in T1 renal masses

Ari P. Bernstein, Ethan B. Fram, Alexander I. Sankin, Evan Z. Kovac, Abhishek Srivastava, Joseph DiVito, Joshua M. Stern

Research output: Contribution to journalArticle

Abstract

Introduction: Recent studies have proposed that nearby fat deposits may have metabolic influence on kidney cancer pathobiology. Both fat quantity and quality may play unique roles in this complex relationship. As such, we investigated whether perinephric fat surface area (PFA), a quantitative measure of fat, or Mayo Adhesive Probability (MAP) score, a qualitative measure, were predictive of malignant pathology or Fuhrman grade in small renal masses. Methods: A total of 317 patients undergoing minimally invasive partial nephrectomy between 2010 and 2016 for renal masses were retrospectively reviewed. Preoperative abdominal CT and MRI scans were measured for PFA and MAP scores. Multiple binary logistic regression models were created to identify predictive factors of malignant disease and Fuhrman grade. Results: A total of 253 patients had malignant masses, while 64 had benign masses. A total of 189 of the malignant masses were T1a, while 64 were designated T1b. A total of 221 patients with malignant masses had reported Fuhrman grades. Of these 211 patients, 143 (64.7%) had low-grade and 78 (35.3%) had high-grade disease. Mean PFA was 18.0 ± 13.3 cm2, while mean MAP score was 2.6 ± 1.2. Binary logistic regression analysis yielded three variables in the best-fit model for predictors of malignant pathology: MAP score (OR = 1.374, 95% CI: 1.007–1.873, P = 0.045), male sex (OR = 2.058, 95% CI: 1.004–4.218, P = 0.049), and BMI (OR = 1.064, 95% CI: 0.998–1.135, P = 0.059). Neither MAP nor PFA was predictive of Fuhrman grade. Conclusions: MAP score, a measure of perinephric fat quality, but not PFA, a qualitative measure of fat quantity, was predictive of malignant pathology, raising the question whether fat quality rather than quantity may be involved in the pathophysiology of RCC in a large and diverse patient population. Understanding the increasing burden of obesity, further studies are needed to elaborate on these findings and to discern the exact relationship between perinephric fat deposits and renal tumorigenesis.

LanguageEnglish (US)
Pages499.e17-499.e22
JournalUrologic Oncology: Seminars and Original Investigations
Volume36
Issue number11
DOIs
StatePublished - Nov 1 2018

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Fats
Kidney
Neoplasms
Logistic Models
Pathology
Kidney Neoplasms
Nephrectomy
Carcinogenesis
Obesity
Regression Analysis
Magnetic Resonance Imaging
Population

Keywords

  • Malignancy
  • MAP
  • Perinephric fat
  • RCC
  • Renal mass

ASJC Scopus subject areas

  • Oncology
  • Urology

Cite this

A comparison of perinephric fat surface area and Mayo Adhesive Probability score in predicting malignancy in T1 renal masses. / Bernstein, Ari P.; Fram, Ethan B.; Sankin, Alexander I.; Kovac, Evan Z.; Srivastava, Abhishek; DiVito, Joseph; Stern, Joshua M.

In: Urologic Oncology: Seminars and Original Investigations, Vol. 36, No. 11, 01.11.2018, p. 499.e17-499.e22.

Research output: Contribution to journalArticle

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title = "A comparison of perinephric fat surface area and Mayo Adhesive Probability score in predicting malignancy in T1 renal masses",
abstract = "Introduction: Recent studies have proposed that nearby fat deposits may have metabolic influence on kidney cancer pathobiology. Both fat quantity and quality may play unique roles in this complex relationship. As such, we investigated whether perinephric fat surface area (PFA), a quantitative measure of fat, or Mayo Adhesive Probability (MAP) score, a qualitative measure, were predictive of malignant pathology or Fuhrman grade in small renal masses. Methods: A total of 317 patients undergoing minimally invasive partial nephrectomy between 2010 and 2016 for renal masses were retrospectively reviewed. Preoperative abdominal CT and MRI scans were measured for PFA and MAP scores. Multiple binary logistic regression models were created to identify predictive factors of malignant disease and Fuhrman grade. Results: A total of 253 patients had malignant masses, while 64 had benign masses. A total of 189 of the malignant masses were T1a, while 64 were designated T1b. A total of 221 patients with malignant masses had reported Fuhrman grades. Of these 211 patients, 143 (64.7{\%}) had low-grade and 78 (35.3{\%}) had high-grade disease. Mean PFA was 18.0 ± 13.3 cm2, while mean MAP score was 2.6 ± 1.2. Binary logistic regression analysis yielded three variables in the best-fit model for predictors of malignant pathology: MAP score (OR = 1.374, 95{\%} CI: 1.007–1.873, P = 0.045), male sex (OR = 2.058, 95{\%} CI: 1.004–4.218, P = 0.049), and BMI (OR = 1.064, 95{\%} CI: 0.998–1.135, P = 0.059). Neither MAP nor PFA was predictive of Fuhrman grade. Conclusions: MAP score, a measure of perinephric fat quality, but not PFA, a qualitative measure of fat quantity, was predictive of malignant pathology, raising the question whether fat quality rather than quantity may be involved in the pathophysiology of RCC in a large and diverse patient population. Understanding the increasing burden of obesity, further studies are needed to elaborate on these findings and to discern the exact relationship between perinephric fat deposits and renal tumorigenesis.",
keywords = "Malignancy, MAP, Perinephric fat, RCC, Renal mass",
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T1 - A comparison of perinephric fat surface area and Mayo Adhesive Probability score in predicting malignancy in T1 renal masses

AU - Bernstein, Ari P.

AU - Fram, Ethan B.

AU - Sankin, Alexander I.

AU - Kovac, Evan Z.

AU - Srivastava, Abhishek

AU - DiVito, Joseph

AU - Stern, Joshua M.

PY - 2018/11/1

Y1 - 2018/11/1

N2 - Introduction: Recent studies have proposed that nearby fat deposits may have metabolic influence on kidney cancer pathobiology. Both fat quantity and quality may play unique roles in this complex relationship. As such, we investigated whether perinephric fat surface area (PFA), a quantitative measure of fat, or Mayo Adhesive Probability (MAP) score, a qualitative measure, were predictive of malignant pathology or Fuhrman grade in small renal masses. Methods: A total of 317 patients undergoing minimally invasive partial nephrectomy between 2010 and 2016 for renal masses were retrospectively reviewed. Preoperative abdominal CT and MRI scans were measured for PFA and MAP scores. Multiple binary logistic regression models were created to identify predictive factors of malignant disease and Fuhrman grade. Results: A total of 253 patients had malignant masses, while 64 had benign masses. A total of 189 of the malignant masses were T1a, while 64 were designated T1b. A total of 221 patients with malignant masses had reported Fuhrman grades. Of these 211 patients, 143 (64.7%) had low-grade and 78 (35.3%) had high-grade disease. Mean PFA was 18.0 ± 13.3 cm2, while mean MAP score was 2.6 ± 1.2. Binary logistic regression analysis yielded three variables in the best-fit model for predictors of malignant pathology: MAP score (OR = 1.374, 95% CI: 1.007–1.873, P = 0.045), male sex (OR = 2.058, 95% CI: 1.004–4.218, P = 0.049), and BMI (OR = 1.064, 95% CI: 0.998–1.135, P = 0.059). Neither MAP nor PFA was predictive of Fuhrman grade. Conclusions: MAP score, a measure of perinephric fat quality, but not PFA, a qualitative measure of fat quantity, was predictive of malignant pathology, raising the question whether fat quality rather than quantity may be involved in the pathophysiology of RCC in a large and diverse patient population. Understanding the increasing burden of obesity, further studies are needed to elaborate on these findings and to discern the exact relationship between perinephric fat deposits and renal tumorigenesis.

AB - Introduction: Recent studies have proposed that nearby fat deposits may have metabolic influence on kidney cancer pathobiology. Both fat quantity and quality may play unique roles in this complex relationship. As such, we investigated whether perinephric fat surface area (PFA), a quantitative measure of fat, or Mayo Adhesive Probability (MAP) score, a qualitative measure, were predictive of malignant pathology or Fuhrman grade in small renal masses. Methods: A total of 317 patients undergoing minimally invasive partial nephrectomy between 2010 and 2016 for renal masses were retrospectively reviewed. Preoperative abdominal CT and MRI scans were measured for PFA and MAP scores. Multiple binary logistic regression models were created to identify predictive factors of malignant disease and Fuhrman grade. Results: A total of 253 patients had malignant masses, while 64 had benign masses. A total of 189 of the malignant masses were T1a, while 64 were designated T1b. A total of 221 patients with malignant masses had reported Fuhrman grades. Of these 211 patients, 143 (64.7%) had low-grade and 78 (35.3%) had high-grade disease. Mean PFA was 18.0 ± 13.3 cm2, while mean MAP score was 2.6 ± 1.2. Binary logistic regression analysis yielded three variables in the best-fit model for predictors of malignant pathology: MAP score (OR = 1.374, 95% CI: 1.007–1.873, P = 0.045), male sex (OR = 2.058, 95% CI: 1.004–4.218, P = 0.049), and BMI (OR = 1.064, 95% CI: 0.998–1.135, P = 0.059). Neither MAP nor PFA was predictive of Fuhrman grade. Conclusions: MAP score, a measure of perinephric fat quality, but not PFA, a qualitative measure of fat quantity, was predictive of malignant pathology, raising the question whether fat quality rather than quantity may be involved in the pathophysiology of RCC in a large and diverse patient population. Understanding the increasing burden of obesity, further studies are needed to elaborate on these findings and to discern the exact relationship between perinephric fat deposits and renal tumorigenesis.

KW - Malignancy

KW - MAP

KW - Perinephric fat

KW - RCC

KW - Renal mass

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