Artificial intelligence-based multimodal prediction for nuclear grading status and prognosis of clear cell renal cell carcinoma: a multicenter cohort study

作者：Qingyuan Zheng, Haonan Mei, Xiaodong Weng, Rui Yang, Panpan Jiao, Xinmiao Ni, Xiangxiang Yang, Jiejun Wu, Junjie Fan, Jingping Yuan, Xiuheng Liu, Zhiyuan Chen · 发表于：International Journal of Surgery · 年份：2025 · DOI：10.1097/js9.0000000000002368 · 被引用次数：14 · 研究领域：Renal cell carcinoma treatment、AI in cancer detection、Radiomics and Machine Learning in Medical Imaging

BACKGROUND: The assessment of the International Society of Urological Pathology (ISUP) nuclear grade is crucial for the management and treatment of clear cell renal cell carcinoma (ccRCC). This study aimed to explore the value of using integrated multimodal information for ISUP grading and prognostic stratification in ccRCC patients, to guide postoperative adjuvant therapy. METHODS: This retrospective study analyzed a total of 729 patients from three cohorts, utilizing whole slide i-mages and computed tomography (CT) images. Artificial intelligence algorithms were used to extract morphological and textural features from whole slide images and CT images separately, creating single-modality predictive models for ISUP grading. By combining the CT and pathology single-modality predictive features, a multimodal predictive signature (MPS) was developed. The prognostic performance of the MPS model was further validated in two independent cohorts. RESULTS: The single-modality predictive models for CT and pathology performed well in predicting ISUP grade for ccRCC. The MPS model achieved higher area under the curve values of 0.95, 0.93, and 0.95 across three independent patient cohorts. Additionally, the MPS model was able to distinguish patients with poorer overall survival. In the external validation cohort, uni- and multivariate analyses showed hazard ratios of 2.542 (95% confidence interval [CI]: 1.363-4.741, P < 0.0001) and 1.723 (95% CI: 0.888-3.357, P = 0.003), respectively. Th...