XÂY DỰNG VÀ ĐÁNH GIÁ HIỆU QUẢ CTSCORET3A TRONG PHÁT HIỆN XÂM LẤN TĨNH MẠCH THẬN GIAI ĐOẠN PT3A TRÊN NỀN HÌNH ẢNH CLVT

Abstract

Objective: To develop and evaluate the predictive value of the CTScoreT3a, a CT-based scoring model, in preoperatively predicting pathological renal vein invasion (pT3a) in patients with RCC. Methods: A retrospective descriptive study was conducted on 301 patients with localized RCC who underwent nephrectomy at Binh Dan Hospital from 2020 to 2024. All patients underwent contrast-enhanced abdominal CT and had postoperative histopathological confirmation. The CTScoreT3a was constructed using logistic regression based on four variables: patient age, tumor size, presence of pseudocapsule, and tumor shape. The diagnostic performance of the score was assessed using ROC curve analysis and standard diagnostic indices. Results: Among 301 patients, 25 cases (8.31%) had pathological renal vein invasion (pT3a). The CTScoreT3a was calculated using the formula: CTScoreT3a = age × 0.056 + tumor diameter × 0.42 – pseudocapsule × 1.595 + tumor shape × 1.313. At the optimal cutoff of 25.5, the model yielded a sensitivity of 96%, specificity of 62.7%, positive predictive value of 18.3%, and negative predictive value of 99.3%. The area under the ROC curve was 0.864 (95% CI: 0.809–0.918). Conclusion: CTScoreT3a is a simple, clinically applicable scoring system with high sensitivity and excellent negative predictive value. It may serve as a useful tool for preoperative screening and risk stratification of pathological T3a renal vein invasion in RCC patients.