OBJECTIVE To explore whether sex-specific abdominal visceral fat composition on CT can predict the Fuhrman nuclear grade of clear cell renal cell carcinoma (ccRCC). METHODS One hundred seventy-one patients (123 males and 48 females) from four hospitals (multicentre group) and 159 patients (109 males and 50 females) from the cancer imaging archive (TCIA-KIRC group) with pathologically proven ccRCC (multicentre: 124 low grade and 47 high grade; TCIA-KIRC: 79 low grade and 80 high grade) were retrospectively included. Abdominal fat was segmented into subcutaneous fat area (SFA) and visceral fat area (VFA) on CT using ImageJ. The total fat area (TFA) and relative VFA (rVFA) were then calculated. Clinical characteristics (age, sex, waist circumference and maximum tumour diameter) were also assessed. Univariate and multivariate logistic regression analyses were performed to identify the association between general or sex-specific visceral fat composition and Fuhrman grade. RESULTS Females with high-grade ccRCC from the multicentre group had a higher rVFA (42.4 vs 31.3, p = 0.001) than those with low-grade ccRCC after adjusting for age. There was no significant difference in males. The rVFA remained a stable and independent predictor for females high-grade ccRCC in both the univariate (multicentre: OR 1.205, 95% CI 1.074-1.352, p = 0.001; TCIA-KIRC: OR 1.171, 95% CI 1.016-1.349, p = 0.029) and multivariate (multicentre: OR 1.095, 95% CI 1.024-1.170, p = 0.003; TCIA-KIRC: OR 1.103, 95% CI 1.024-1.187, p = 0.010) models. CONCLUSIONS Sex-specific visceral fat composition has different values for predicting high-grade ccRCC and could be used as an independent predictor for females with high-grade ccRCC. KEY POINTS • Visceral fat measurement (rVFA) as an independent predictor for high-grade ccRCC had good predictive power in females, but not in males. • Sex-specific visceral fat composition was significantly associated with high-grade ccRCC in females only. • The rVFA could be considered one of the risk factors for high-grade ccRCC for females.

中文翻译：

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透明细胞肾细胞癌：在CT上测量的性别特异性腹部内脏脂肪对预测Fuhrman核级的价值。

目的探讨CT上具有性别特异性的腹部内脏脂肪成分是否可以预测透明细胞肾细胞癌（ccRCC）的Fuhrman核级。方法：来自四家医院（多中心组）的171例患者（123例男性和48名女性）和来自癌症影像学档案（TCIA-KIRC组）的159例患者（109例男性和50例女性）经病理证实的ccRCC（多中心：124个）低级和47级； TCIA-KIRC：79级和80级）。使用ImageJ在CT上将腹部脂肪分为皮下脂肪区（SFA）和内脏脂肪区（VFA）。然后计算总脂肪面积（TFA）和相对VFA（rVFA）。还评估了临床特征（年龄，性别，腰围和最大肿瘤直径）。进行单因素和多因素logistic回归分析以鉴定一般或性别特异性内脏脂肪成分与Fuhrman等级之间的关联。结果在校正了年龄后，多中心组具有较高ccRCC的女性的rVFA较高（42.4 vs 31.3，p = 0.001）。男性之间没有显着差异。在单变量中，rVFA仍然是女性高级ccRCC的稳定且独立的预测指标（多中心：OR 1.205，95％CI 1.074-1.352，p = 0.001; TCIA-KIRC：OR 1.171，95％CI 1.016-1.349，p = 0.029）和多变量（多中心：OR 1.095，95％CI 1.024-1.170，p = 0.003; TCIA-KIRC：OR 1.103，95％CI 1.024-1.187，p = 0.010）模型。结论性别特异性内脏脂肪成分对高等级ccRCC的预测具有不同的值，可以用作女性高等级ccRCC的独立预测因子。要点•内脏脂肪测量（rVFA）作为高级ccRCC的独立预测因子，对女性具有良好的预测能力，而对男性则没有。•特定性别的内脏脂肪成分仅与女性的高级ccRCC显着相关。•rVFA被认为是女性高级ccRCC的危险因素之一。