ArticleInternational urology and nephrology2026
Preoperative non-contrast CT-derived adiposity quantity and attenuation predict recurrence-free survival after nephrectomy for localized clear cell renal cell carcinoma.
Article in International urology and nephrology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeTo assess whether preoperative non-contrast CT-derived adiposity quantity and attenuation are independently associated with recurrence-free survival (RFS) after surgery for localized clear cell renal cell carcinoma (ccRCC).
methodsWe performed a single-center retrospective cohort study of adults with pathologically confirmed ccRCC who underwent upfront partial or radical nephrectomy and had preoperative non-contrast abdominal CT within 30 days. A single mid-L3 axial slice was segmented for subcutaneous (SAT) and visceral adipose tissue (VAT) using predefined thresholds (SAT-190 to -30 HU; VAT-150 to-50 HU). Adiposity indices were normalized by height squared (SATI, VATI), and mean SAT/VAT attenuation (HU) was recorded. RFS was defined as time from surgery to first documented local/regional recurrence or distant metastasis. Multi-variable Cox models were adjusted for age, sex, chronic disease history, tumor diameter, surgery type, and WHO/ISUP grade; continuous predictors were standardized (per 1-SD). Incremental prognostic performance beyond the clinicopathologic base model was assessed using Harrell's C-index.
resultsAmong 598 patients, 151 (25.3%) developed recurrence/metastasis. Higher SATI and VATI were associated with longer RFS in separate adjusted models (per 1-SD: SATI HR 0.55, 95% CI 0.44-0.68; VATI HR 0.63, 0.53-0.76). Higher (less negative) attenuation was associated with shorter RFS in separate adjusted models (SAT HU HR 1.29, 1.12-1.48; VAT HU HR 1.40, 1.21-1.60). In joint models, the SATI association remained robust, whereas VATI and VAT attenuation were attenuated. The apparent C-index of the clinicopathologic base model improved from 0.667 to 0.707 after adding SATI and to 0.713 after adding SATI + VATI.
conclusionRoutine preoperative non-contrast CT measures of adiposity quantity, and to a lesser extent attenuation, provide prognostic information for postoperative RFS in localized ccRCC. In this localized surgery-treated cohort, SATI was the most stable independent marker and modestly improved discrimination beyond clinicopathologic factors.
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