A comparative study of tumor markers and dynamic contrast-enhanced CT and their combined evaluation in the diagnosis of renal cancer patients

The objectives of this study were to investigate the diagnostic efficacy of dynamic contrast-enhanced Computed Tomography (CT) and tumor markers and their combined evaluation in renal cancer patients. A total of eighty male patients with solid renal lesions were selected from our hospital and categorized into two groups based on pathological examination findings: renal cancer group and benign lesion group. A comparison was made between the findings of dynamic contrast-enhanced CT and tumor markers and the diagnostic efficacy of either mono or combined evaluation were compared. Receiver operating characteristic curves were plotted to better analyze and compare different diagnostic techniques. The serum concentrations of carcinoembryonic antigen (CEA), Cytokeratin 19 fragment (CYFRA21-1), midkine (MK) and matrix metalloproteinase 9 (MMP-9) in renal cancer patients were significantly higher than those with benign lesions (p < 0.05). The Receiver Operating Characteristic (ROC) curve analysis demonstrated that the combination of dynamic contrast-enhanced CT and tumor markers had the highest area under the curve. This difference was statistically significant (p < 0.05). The analysis of the overall model quality results revealed that the model values for both single and combination indicators exceeded 0.5, with the combined indicators having the highest value of (0.84). The diagnostic efficacy of dynamic contrast-enhanced CT combined with tumor markers for renal cancer is significantly higher than either the dynamic contrast-enhanced CT or tumor markers alone. The combination of dynamic contrast-enhanced CT and tumor markers has a significant therapeutic benefit in diagnosing renal cancer. We envisage that, this approach can offer valuable guidance for the clinical diagnosis and treatment of renal cancer.

Dynamic contrast-enhanced CT; Tumor markers; Combined examination; Renal cancer; Diagnostic efficacy

[1] Życzkowski M, Kaletka Z, Rajwa P, Rempega G, Stelmach P, Bogacki R, et al. Mean platelet volume-to-lymphocyte ratio: a novel biomarker associated with overall survival in patients with nonmetastatic clear cell renal cell carcinoma treated with nephrectomy. International Urology and Nephrology. 2020; 52: 885–891.

[2] Życzkowski M, Rajwa P, Gabrys E, Jakubowska K, Jantos E, Paradysz A. The relationship between red cell distribution width and cancer-specific survival in patients with renal cell carcinoma treated with partial and radical nephrectomy. Clinical Genitourinary Cancer. 2018; 16: e677–e683.

[3] Zurita AJ, Jonasch E, Wu HK, Tran HT, Heymach JV. Circulating biomarkers for vascular endothelial growth factor inhibitors in renal cell carcinoma. Cancer. 2009; 115: 2346–2354.

[4] Zurita AJ, Jonasch E, Wang X, Khajavi M, Yan S, Du DZ, et al. A cytokine and angiogenic factor (CAF) analysis in plasma for selection of sorafenib therapy in patients with metastatic renal cell carcinoma. Annals of Oncology. 2012; 23: 46–52.

[5] Zuo H, Tell GS, Vollset SE, Ueland PM, Nygård O, Midttun Ø, et al. Interferon-γ-induced inflammatory markers and the risk of cancer: the Hordaland Health Study. Cancer. 2014; 120: 3370–3377.

[6] Zumrutdal E, Tolga Sahin T, Kulahci Ö, Bilecik T, Temiz Ö, Cetinkunar S, et al. The effect of peritoneal dialysis with alkaline dialysate in peritonitis carcinomatosis: an experimental study in mice. Giornale di Chirurgia. 2018; 39: 215–222.

[7] Zumkeller W, Schwander J, Mitchell CD, Morrell DJ, Schofield PN, Preece MA. Insulin-like growth factor (IGF)-I, -II and IGF binding protein-2 (IGFBP-2) in the plasma of children with Wilms’ tumour. European Journal of Cancer. 1993; 29A: 1973–1977.

[8] Zuluaga Gómez A, Lara Jiménez P, Martínez Torres JL, De la Fuente Serrano A, Miján Ortiz JL, Nogueras Ocaña M, et al. Localized renal adenocarcinoma. Prognostic factors and influence of postoperative irradiation on survival. Actas Urológicas Españolas. 1992; 16: 385–388. (In Spanish)

[9] Zuiverloon TC, Boormans JL, Trapman J, van Leenders GJ, Zwarthoff EC. No evidence of FGFR3 mutations in prostate cancer. The Prostate. 2011; 71: 637–641.

[10] Zudaire Bergera JJ, Rincón Mayans A, Rioja Zuazu J, Barba Abad J, Romero Vargas L, Algarra Navarro R, et al. Renal cell carcinoma molecular biology. Prognostic and therapeutic usefulness. Archivos Españoles de Urología. 2013; 66: 23–32. (In Spanish)

[11] Mannas MP, Deng FM, Belanger EC, Jones D, Ren J, Huang W, et al. Stimulated Raman histology as a method to determine the adequacy of renal mass biopsy and identify malignant subtypes of renal cell carcinoma. Urologic Oncology. 2023; 41: 328.e9–328.e13.

[12] Tian Y, Fan X, Chen K, Chen X, Peng W, Wang L, et al. Optical biomarker analysis for renal cell carcinoma obtained from preoperative and postoperative patients using ATR-FTIR spectroscopy. Spectrochimica Acta Part A: Biolecular and Biomolecular Spectroscopy. 2024; 318: 124426.

[13] Liu DH, Dani KA, Reddy SS, Lei X, Demirjian NL, Hwang DH, et al. Radiogenomic associations clear cell renal cell carcinoma: an exploratory study. Oncology. 2023; 101: 375–388.

[14] Zucca LE, Morini Matushita MA, da Silva Oliveira RJ, Scapulatempo-Neto C, de Lima MA, Ribeiro GG, et al. Expression of tyrosine kinase receptor AXL is associated with worse outcome of metastatic renal cell carcinomas treated with sunitinib. Urologic Oncology. 2018; 36: 11.e13–11.e21.

[15] Zubaľ M, Výmolová B, Matrasová I, Výmola P, Vepřková J, Syrůček M, et al. Fibroblast activation protein as a potential theranostic target in brain metastases of diverse solid tumours. Pathology. 2023; 55: 806–817.

[16] Zubakov D, Stupar Z, Kovacs G. Differential expression of a new isoform of DLG2 in renal oncocytoma. BMC Cancer. 2006; 6: 106.

[17] Zubac DP, Wentzel-Larsen T, Seidal T, Bostad L. Type 1 plasminogen activator inhibitor (PAI-1) in clear cell renal cell carcinoma (CCRCC) and its impact on angiogenesis, progression and patient survival after radical nephrectomy. BMC Urology. 2010; 10: 20.

[18] Zubac DP, Bostad L, Kihl B, Seidal T, Wentzel-Larsen T, Haukaas SA. The expression of thrombospondin-1 and p53 in clear cell renal cell carcinoma: its relationship to angiogenesis, cell proliferation and cancer specific survival. The Journal of Urology. 2009; 182: 2144–2149.

[19] Zhang W, Wang J, Chen L. Characteristics of high frame frequency contrast-enhanced ultrasound in renal tumors. BMC Medical Imaging. 2024; 24: 71.

[20] Zhang J, Liu C, Zheng Z, Liu Y, Li Y, Hu H, et al. Budd-Chiari syndrome: the “inferior vena cava reverse-flow” sign and “jet-blood” sign on CT and MRI. European Journal of Radiology. 2020; 132: 109288.

[21] Zeng H, Zhang M, Xie Y, Wang M, Dai J, Zhu X, et al. Primary renal mucinous adenocarcinoma masquerading as a giant renal cyst: a case report. Frontiers in Oncology. 2023; 13: 1129680.

[22] Yan J, Cheng JL, Li CF, Lian YB, Zheng Y, Zhang XP, et al. The findings of CT and MRI in patients with metanephric adenoma. Diagnostic Pathology. 2016; 11: 104.

[23] Yamashita Y, Miyazaki T, Hatanaka Y, Takahashi M. Dynamic MRI of small renal cell carcinoma. Journal of Computer Assisted Tomography. 1995; 19: 759–765.

[24] Yamamoto A, Tamada T, Higaki A, Arita Y, Ueno Y, Murakami T, et al. Evaluation of the clinical behavior of unclassified renal cell carcinoma and its imaging findings on computed tomography and magnetic resonance imaging based on World Health Organization (WHO) 2022. Japanese Journal of Radiology. 2024; 42: 78–86.

[25] Zyrek-Betts J, Micale M, Lineen A, Chaudhuri PK, Keil S, Xue J. Malignant blue nevus with lymph node metastases. Journal of Cutaneous Pathology. 2008; 35: 651–657.

[26] Zynger DL, McCallum JC, Luan C, Chou PM, Yang XJ. Glypican 3 has a higher sensitivity than alpha-fetoprotein for testicular and ovarian yolk sac tumour: immunohistochemical investigation with analysis of histological growth patterns. Histopathology. 2010; 56: 750–757.

[27] Zynger DL, Gupta A, Luan C, Chou PM, Yang GY, Yang XJ. Expression of glypican 3 in hepatoblastoma: an immunohistochemical study of 65 cases. Human Pathology. 2008; 39: 224–230.

[28] Zynger DL, Dimov ND, Luan C, Teh BT, Yang XJ. Glypican 3: a novel marker in testicular germ cell tumors. American Journal of Surgical Pathology. 2006; 30: 1570–1575.

[29] Li Y, Huang X, Xia Y, Long L. Value of radiomics in differential diagnosis of chromophobe renal cell carcinoma and renal oncocytoma. Abdominal Radiology. 2020; 45: 3193–3201.

[30] Alhussaini AJ, Steele JD, Nabi G. Comparative analysis for the distinction of chromophobe renal cell carcinoma from renal oncocytoma in computed tomography imaging using machine learning radiomics analysis. Cancers. 2022; 14: 3609.