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Research Article: Radiomic model versus R.E.N.A.L. nephrometry score for predicting the likelihood of undergoing partial nephrectomy in clear cell renal cell carcinoma

Date Published: 2026-09-18

Abstract:
To develop a CT-based radiomic model for predicting partial nephrectomy (PN) in clear cell renal cell carcinoma (ccRCC) and compare it with the R.E.N.A.L. Nephrometry Score (RNS). This retrospective study included 413 ccRCC patients who underwent PN or radical nephrectomy. The RNS was calculated from preoperative CT. Radiomic features were extracted from corticomedullary-phase CT. Reproducibility was assessed using intraclass correlation coefficients (ICCs). LASSO regression was used for feature selection and Rad-score construction. Multivariable logistic regression models were built based on the total RNS sum and the Rad-score. Performance was evaluated by AUC, calibration, and decision curve analysis. Of 1210 extracted features (after excluding general_info fields), 851 showed good to excellent reproducibility (ICC > 0.75). The radiomic model (6 selected features) achieved an AUC of 0.886 (95% CI: 0.81-0.91) in the internal validation cohort, significantly outperforming the RNS model (AUC = 0.793, 95% CI: 0.72-0.85; DeLong test, P = 0.015). The radiomic model also demonstrated better calibration (Brier score: 0.11 vs. 0.16) and higher clinical net benefit. SHAP analysis identified tumor size and texture heterogeneity as the strongest predictors. A CT-based radiomic model provides superior accuracy over the RNS for preoperatively predicting PN likelihood in ccRCC and holds significant potential to augment surgical decision-making and personalize treatment planning. Prospective multi-center validation is warranted before routine clinical adoption.

Introduction:
Renal cell carcinoma (RCC) is the seventh most common malignancy globally, with the highest mortality rate among urological cancers ( 1 ). Clear cell RCC (ccRCC), accounting for 70-80% of RCC cases, is the most prevalent histological subtype ( 1 ). Surgical resection remains the cornerstone of curative treatment for localized ccRCC, with partial nephrectomy (PN) and radical nephrectomy (RN) as primary options ( 2 ). PN is the standard of care for localized renal masses, providing oncological outcomes comparable to…

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