ORIGINAL RESEARCH article
Front. Oncol.
Sec. Genitourinary Oncology
Volume 15 - 2025 | doi: 10.3389/fonc.2025.1637032
Integrating Sarcopenia and Non-Contrast CT Radiomics for Preoperative Prediction of Survival in Sarcomatoid Renal Cell Carcinoma
Provisionally accepted- 1The Affiliated Hospital of Qingdao University, Qingdao, China
- 2The Second People's Hospital of Chengyang District, Qingdao, China
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Abstract Background: Sarcomatoid renal cell carcinoma (sRCC) is an aggressive subtype with a poor prognosis. Preoperative prognostic tools are lacking, and the predictive value of sarcopenia combined with radiomic features from non-contrast CT remains unexplored. Methods: In this retrospective study, 121 pathologically confirmed sRCC patients were enrolled. Sarcopenia was assessed using muscle mass measurements at the L3 level on preoperative non-contrast CT. Radiomic features were extracted from tumor regions of interest. Least absolute shrinkage and selection operator (LASSO) and Cox regression were used to select features and construct prognostic models for overall survival (OS). A combined model integrating sarcopenia status and radiomic signature (Rad-score) was developed and evaluated regarding its discrimination, calibration, and clinical utility. Results: Multivariable analysis identified paravertebral muscle-defined sarcopenia (HR = 3.046, p = 0.029), platelet-to-neutrophil ratio, hemoglobin-albumin-lymphocyte-platelet score, tumor size, and N stage as independent prognostic factors. The combined model (clinical + Rad-score) demonstrated superior predictive performance for 1-, 2-, and 3-year OS, with AUCs of 0.849, 0.804, and 0.819, respectively, and significantly outperformed the radiomics-only model (p = 0.002). Calibration curves and decision curve analysis confirmed its clinical applicability. Conclusion: The integration of sarcopenia and non-contrast CT radiomics provides a valuable preoperative tool for predicting survival in sRCC patients, facilitating individualized risk stratification and clinical decision-making.
Keywords: Sarcomatoid Renal Cell carcinoma, Sarcopenia, Radiomics, prognosis, Non-contrast CT, survival analysis, machine learning, Preoperative prediction
Received: 28 May 2025; Accepted: 06 Oct 2025.
Copyright: © 2025 Liu, zhou, Yao, Hu, Sun and Zhang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Guiming Zhang, zhangguiming9@126.com
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