Objective
To identify an objective and reproducible strategy for preoperative staging bone scintigraphy
(BS) in patients diagnosed with renal cell carcinoma (RCC), because in the absence
of objective criteria, the decision to perform preoperative BS remains a subjective
practice.
Patients and Methods
The study included a total of 2008 patients with RCC treated with surgery and prospectively
included into an institutional database. The study outcome was the presence of 1 or
more bone lesions suspicious for metastases at staging BS. A multivariable logistic
regression model predicting a positive BS was fitted. The predictors consisted of
the preoperative clinical tumor (cT) and clinical nodal (cN) stages, the presence
of systemic symptoms, and the platelet-to-hemoglobin (PLT/Hb) ratio.
Results
The rate of positive BS was 4% (n = 81). At the multivariable logistic regression
analysis, cT2, cN1, the presence of systemic symptoms, and the PLT/Hb ratio were all
associated with am increased risk of positive BS (P <.05). Following the 2000-sample bootstrap validation, the concordance index was 0.77
(proposed model) vs 0.63 (decision making based on symptoms only). At the decision
curve analysis, the proposed strategy was associated with a higher net benefit. If
BS is performed when the risk of positive result is >5%, a negative BS is spared in
80% and a positive BS is missed in 2% of the population only.
Conclusion
Using preoperative variables, it is possible to accurately estimate the risk of positive
BS at RCC staging using preoperative characteristics. Compared with the strategy supported
by available guidelines, the proposed model was more objective, statistically more
accurate, and clinically associated with higher net benefit.
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Article info
Publication history
Published online: September 07, 2017
Accepted:
August 29,
2017
Received:
May 1,
2017
Footnotes
Financial Disclosure: The authors declare that they have no relevant financial interests.
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
