There is an increased incidence of renal cell carcinoma (RCC) in patients with metabolic syndrome who usually have high levels of serum triglyceride (TG) and low high-density lipoprotein-cholesterol (HDL-C). Plasma atherogenic index (PAI) is the logarithmic ratio of serum TG level to HDL-C and related to cardiovascular diseases. In this study, we aimed to determine the accuracy of PAI in determining renal malignancy in localized renal masses preoperatively. Totally 169 patients who were diagnosed with Bosniak III-IV lesions by imaging modalities and treated in our hospital with partial or radical nephrectomy were retrospectively analyzed using institutional renal cancer database between 2013 and 2018. Preoperative images were evaluated by two experienced radiologists. The patients were divided into two groups according to their postoperative pathological diagnosis as malignant or benign tumors. The PAI of each patient was calculated and the statistical significance of PAI in predicting malignancy for renal masses was analyzed using uni- and multivariable analyses. Of patients, 109 (64.5%) were males and 60 (35.5%) were females with a median age of 61 (33–84) years. Median tumor size was 6.5 (2–18) cm. Pathological diagnosis was malignant in 145 (85.8%) and benign in 24 (14.2%) patients. There was no statistically significant difference in serum TG levels between malignant and benign cases (p > 0.05). The HDL-C levels were significantly lower in malignant cases (p = 0.001). Median PAI value was 0.63 (0.34–1.58) and significantly higher in malignant cases (p = 0.003). The PAI cut-off value for malignancy was ≥0.34. The sensitivity was calculated as 88.2% and specificity as 45.8%, the positive predictive value as 90.8, negative predictive value as 39.3, and odds ratio as 6.37 (95% CI: 2.466–16.458). In multivariable analysis, gender, smoking status, and hypertension had no effect on malignancy, whereas PAI and HDL-C were independent risk factors (p = 0.003 and p = 0.003, respectively). The risk of malignancy was 5.019 times higher, when PAI was > 0.34 (95% CI: 1.744–14.445) in multivariable logistic regression analysis. The PAI can be used as a predictive tool in suspicion of malignant renal masses. In case of a benign pathology, PAI levels may be encouraging for surgeons for nephron-sparing surgery.

中文翻译：

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血浆动脉粥样硬化指数与Bosniak III-IV肾肿块最终病理之间的关系：一项回顾性单中心研究

代谢综合征患者的肾细胞癌（RCC）发病率增加，这些患者通常血清甘油三酯（TG）水平高而高密度脂蛋白胆固醇（HDL-C）低。血浆动脉粥样硬化指数（PAI）是血清TG水平与HDL-C的对数比，并且与心血管疾病有关。在这项研究中，我们旨在确定术前确定局部肾脏肿块中PAI在确定肾脏恶性肿瘤中的准确性。在2013年至2018年之间，使用机构肾癌数据库回顾性分析了通过影像学方法诊断为Bosniak III-IV病变并在本院接受部分或根治性肾切除术治疗的169例患者。术前影像由两名经验丰富的放射科医生进行评估。根据患者术后病理诊断为恶性或良性肿瘤，将其分为两组。计算每位患者的PAI，并使用单变量和多变量分析对PAI在预测肾肿块恶性程度中的统计学意义进行分析。在患者中，男性为109位（64.5％），女性为60位（35.5％），中位年龄为61岁（33-84岁）。中位肿瘤大小为6.5（2-18）cm。病理诊断为恶性145例（85.8％），良性24例（14.2％）。在恶性和良性病例之间，血清TG水平无统计学差异（p> 0.05）。在恶性病例中，HDL-C水平显着降低（p = 0.001）。PAI中位数为0.63（0.34–1.58），在恶性病例中显着更高（p = 0.003）。恶性肿瘤的PAI临界值≥0.34。计算出的敏感性为88.2％，特异性为45.8％，阳性预测值为90.8，阴性预测值为39.3，优势比为6.37（95％CI：2.466–16.458）。在多变量分析中，性别，吸烟状况和高血压对恶性肿瘤没有影响，而PAI和HDL-C是独立的危险因素（分别为p = 0.003和p = 0.003）。在多变量logistic回归分析中，当PAI> 0.34（95％CI：1.744–14.445）时，恶性肿瘤的风险高5.019倍。PAI可作为怀疑恶性肾脏肿块的预测工具。在良性病理的情况下，PAI水平可能会鼓励外科医生进行保留肾单位的手术。阴性预测值为39.3，优势比为6.37（95％CI：2.466–16.458）。在多变量分析中，性别，吸烟状况和高血压对恶性肿瘤没有影响，而PAI和HDL-C是独立的危险因素（分别为p = 0.003和p = 0.003）。在多变量logistic回归分析中，当PAI> 0.34（95％CI：1.744–14.445）时，恶性肿瘤的风险高5.019倍。PAI可作为怀疑恶性肾脏肿块的预测工具。在良性病理的情况下，PAI水平可能会鼓励外科医生进行保留肾单位的手术。阴性预测值为39.3，优势比为6.37（95％CI：2.466–16.458）。在多变量分析中，性别，吸烟状况和高血压对恶性肿瘤没有影响，而PAI和HDL-C是独立的危险因素（分别为p = 0.003和p = 0.003）。在多变量logistic回归分析中，当PAI> 0.34（95％CI：1.744–14.445）时，恶性肿瘤的风险高5.019倍。PAI可作为怀疑恶性肾脏肿块的预测工具。在良性病理的情况下，PAI水平可能会鼓励外科医生进行保留肾单位的手术。分别）。在多变量logistic回归分析中，当PAI> 0.34（95％CI：1.744–14.445）时，恶性肿瘤的风险高5.019倍。PAI可作为怀疑恶性肾脏肿块的预测工具。在良性病理的情况下，PAI水平可能会鼓励外科医生进行保留肾单位的手术。分别）。在多变量logistic回归分析中，当PAI> 0.34（95％CI：1.744–14.445）时，恶性肿瘤的风险高5.019倍。PAI可作为怀疑恶性肾脏肿块的预测工具。在良性病理的情况下，PAI水平可能会鼓励外科医生进行保留肾单位的手术。