Clinical imaging · 2025
Node-RADS score on CT imaging predicts lymph node metastasis and survival in renal cell carcinoma: A multicenter diagnostic study.
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Gu Donghua, Shen Cheng, Zhu Hua, Chen Jiangang, Gu Zhibo, Chang Jing, Zheng Bing
Аннотация
PURPOSE: To evaluate the diagnostic performance of Node-RADS for assessing regional lymph node metastasis (RLNM) in renal cell carcinoma (RCC) by computed tomography (CT) and explore its prognostic value.
MATERIALS AND METHODS: This retrospective study included 250 RCC patients who underwent nephrectomy and RLN dissection (2018-2024). Two radiologists independently evaluated lymph nodes using Node-RADS. Receiver operating characteristic (ROC) curves assessed predictive performance for RLNM. Inter- and intra-observer agreement was analyzed with Cohen's kappa. A nomogram integrating clinical variables and Node-RADS was constructed. Overall survival (OS) was compared between low (Node-RADS 1-3) and high (Node-RADS 4-5) score groups.
RESULTS: Of 250 patients, 61 had RLNM. Subtype, T category, Fuhrman grade, distant metastasis, tumor size, systemic methods, and Node-RADS differed significantly between groups (all P < 0.05). AUC values for Node-RADS cutoffs were as follows: ≥4 (0.88), ≥3 (0.86), ≥5 (0.83), and ≥ 2 (0.76). Inter-observer agreement was 0.75, and intra-observer agreement was 0.82 (both P < 0.001). The newly developed nomogram demonstrated superior predictive performance for RLNM status compared to Node-RADS score, T classification, and distant metastasis, with significantly higher AUC values (0.960 vs. 0.880, 0.810, and 0.700, respectively; all P < 0.001). High Node-RADS scores were associated with shorter median OS (24.2 months vs. not reached; P < 0.001).
CONCLUSIONS: CT-based Node-RADS shows high accuracy for RLNM prediction and provides clinically relevant prognostic information in RCC.
MATERIALS AND METHODS: This retrospective study included 250 RCC patients who underwent nephrectomy and RLN dissection (2018-2024). Two radiologists independently evaluated lymph nodes using Node-RADS. Receiver operating characteristic (ROC) curves assessed predictive performance for RLNM. Inter- and intra-observer agreement was analyzed with Cohen's kappa. A nomogram integrating clinical variables and Node-RADS was constructed. Overall survival (OS) was compared between low (Node-RADS 1-3) and high (Node-RADS 4-5) score groups.
RESULTS: Of 250 patients, 61 had RLNM. Subtype, T category, Fuhrman grade, distant metastasis, tumor size, systemic methods, and Node-RADS differed significantly between groups (all P < 0.05). AUC values for Node-RADS cutoffs were as follows: ≥4 (0.88), ≥3 (0.86), ≥5 (0.83), and ≥ 2 (0.76). Inter-observer agreement was 0.75, and intra-observer agreement was 0.82 (both P < 0.001). The newly developed nomogram demonstrated superior predictive performance for RLNM status compared to Node-RADS score, T classification, and distant metastasis, with significantly higher AUC values (0.960 vs. 0.880, 0.810, and 0.700, respectively; all P < 0.001). High Node-RADS scores were associated with shorter median OS (24.2 months vs. not reached; P < 0.001).
CONCLUSIONS: CT-based Node-RADS shows high accuracy for RLNM prediction and provides clinically relevant prognostic information in RCC.