ArticleQuantitative imaging in medicine and surgery2026
Association of renal artery variations with aggressive pathological features and poor prognosis in clear-cell renal cell carcinoma: a computed tomography-based three-dimensional reconstruction study.
Article in Quantitative imaging in medicine and surgery, 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
Background: Clear-cell renal cell carcinoma (ccRCC), the most common subtype of kidney cancer, is characterized by its hypervascular nature. Its dependence on neo-angiogenesis is well-documented; however, the relationship between congenital vascular architecture and tumor biology remains obscure. This study aimed to investigate the association between pre-existing renal artery variation and ccRCC aggressiveness and patient prognosis. Methods: This retrospective study included the clinicopathological and imaging data of 386 patients with ccRCC. Preoperative computed tomography images underwent three-dimensional (3D) reconstruction to evaluate renal artery variations. Using a self-controlled design, a total of 772 renal units were analyzed. Appropriate parametric and non-parametric tests were performed to compare renal artery variations between tumor-affected kidneys and contralateral healthy kidneys, and to further evaluate the association between renal artery variations and clinicopathological characteristics. Further, a Kaplan-Meier survival analysis and multivariate Cox proportional hazards regression models were employed to evaluate the impact of renal artery variations on survival outcomes, including progression-free survival (PFS) and overall survival (OS), and to identify independent prognostic factors. Results: The incidence of renal artery variations was significantly higher in the ccRCC-affected kidneys (66.3%) than in the contralateral healthy kidneys (P<0.001). Among the variations, accessory renal artery (ARA) was the most common type (45.3%), with both its number (P<0.001) and origin (P<0.001) exhibiting greater complexity. ARA was significantly associated with several aggressive clinicopathological features, including exophytic growth (P=0.015), a larger tumor diameter (P<0.001), an increased tumor volume (P<0.001), pathological necrosis (P<0.001), and a higher World Health Organization/International Society of Urological Pathology (WHO/ISUP) grade (P=0.028). In addition, tumor-feeding ARAs were associated with higher rates of intratumoral hemorrhage (P=0.038) and cystic degeneration (P=0.025). The Kaplan-Meier analysis revealed that the presence of ARAs was significantly associated with shorter OS (P<0.001) and PFS (P<0.001). The multivariate Cox regression analysis further identified the presence of ARAs as an independent prognostic factor for PFS (hazard ratio =8.33, P=0.047). Conclusions: Renal artery variations are common in patients with ccRCC. Specifically, the presence of ARAs is closely associated with aggressive tumor growth patterns, pathological characteristics, and a poorer prognosis. These findings suggest that ARAs may play a crucial role in tumor development and progression.
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