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The preoperative predictive factors for pathological T3a upstaging and positive surgical margin of clinical T1 renal cell carcinoma
Factores preoperatorios predictivos del incremento a estadio patológico T3a y márgenes quirúrgicos positivos en el carcinoma de células renales en estadio clínico T1
G. Çil
Corresponding author
cilgok@gmail.com

Corresponding author.
, M. Yilmaz, Y. Sahin, İ. Ulus, İ.O. Canıtez, İ.E. Kandıralı
Servicio de Urología, Universidad de Ciencias de la Salud, Hospital de Formación e Investigación Bagcilar, Estambul, Turkey
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        "titulo" => "Factores preoperatorios predictivos del incremento a estadio patol&#243;gico T3a y m&#225;rgenes quir&#250;rgicos positivos en el carcinoma de c&#233;lulas renales en estadio cl&#237;nico T1"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Renal cell carcinoma &#40;RCC&#41; is the most common type of solid lesion in the kidney and is also the third most common type of tumor among all urological tumors&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> Given its better preservation of kidney functions and its benefits in terms of cardiac outcomes&#44; partial nephrectomy &#40;PN&#41; has become the preferred treatment method&#44; especially for small masses&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> However&#44; the efficacy of PN in the treatment method of more advanced&#44; large and complex masses is controversial&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> In addition to perirenal adipose tissue invasion&#44; the tumor extending into the renal vein or its segmental branches or invading the pelvicalyceal system but not exceeding Gerota&#39;s fascia is also considered cT3a&#46; Even in cases where the tumor is clinically small&#44; various causes &#40;edema&#44; vascular occlusion&#44; hematoma&#44; or necrosis&#41; may lead to septal thickening in the perirenal area&#46; Perirenal adipose tissue invasion can be more difficult to detect compared to other parameters which may be misleading in staging&#44; causing a risk of upgrade to pathological T3a &#40;pT3a&#41; and surgical margin positivity risk in patients undergoing PN considering clinical T1 &#40;cT1&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a> There are different opinions in studies on the follow-up and management of patients with positive surgical margins &#40;PSM&#41;&#46; The majority of retrospective studies performed showed that PSM did not translate into a higher risk of metastasis or reduced cancer specific survival &#40;CSS&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Another&#44; single-center&#44; retrospective study with a large number of cases showed that PSM is an independent predictor of progression free survival &#40;PFS&#41; due to the higher incidence of distant and local relapses&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> In another study of 42&#44;112 patients showed an increased presence of PSM in upstaged pT3a tumours&#44; increased all-cause mortality in PSM patients and a decreased 5-year overall survival &#40;OS&#41; rate in pT3a tumours&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> We think that accurate staging of patients in the pre-operative period would be important in terms of treatment success and predicting the course of the disease&#46; The objective of this study is to investigate the factors that may pre-operatively predict PSM and pT3a upstaging in patients with cT1 RCC&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0010" class="elsevierStylePara elsevierViewall">The population of this retrospecive study consisted of 217 patients who were diagnosed with cT1 RCC and underwent radical nephrectomy &#40;RN&#41; or PN &#40;open or laparoscopic&#41; surgery in our clinic between October 2016 and September 2022&#46; The study protocol was approved by the institutional ethics committee prior to the conduct of the study &#40;approval number&#58; 2023&#47;05&#47;02&#47;021&#41;&#46; Patients with inflammatory allergic diseases&#44; missing data&#44; positive lymph nodes&#44; non-RCC pathology&#44; and distant metastases were excluded from the study&#46; In the end&#44; a total of 159 patients were included in the study&#46; We evaluated the pre-operative demographic&#44; laboratory&#44; radiological and pathological characteristics of all patients&#46; Accordingly&#44; patients&#8217; age&#44; gender&#44; comorbidity&#44; complete blood count &#40;CBC&#41;&#44; albumin&#44; alkaline phosphatase &#40;ALP&#41;&#44; albumin-to-alkaline phosphatase ratio &#40;AAPR&#41;&#44; aspartate transaminase &#40;AST&#41;&#44; alanine transaminase &#40;ALT&#41;&#44; systemic immune-inflammation index &#40;SII&#41; and De Ritis ratios &#40;DRR&#41; data were recorded&#46; SII was calculated based on the formula of platelet count&#8239;&#215;&#8239;neutrophil count&#47;lymphocyte count&#44; whereas DRR was calculated based on the formula of serum level of AST&#47;serum level of ALT&#46; All laboratory tests were performed within 1 week before surgery&#46; Radiological parameters &#40;tumor diameter&#44; tumor-side perirenal adipose tissue in Hounsfield units&#44; etc&#46;&#41;&#44; renal nephrometry score &#40;RNS&#41; &#40;tumor size&#44; endophytic&#47;exophytic nature&#44; distance to the collecting duct system&#44; anterior&#47;posterior localization&#44; relationship of the tumor to the polar appendages&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> were evaluated&#46; The dimensions of the tumor were measured by two radiologists in three planes &#40;coronal&#44; sagittal and axial&#41; with contrast-enhanced computed tomography &#40;CT&#41;&#46; Pathological and clinical tumor characteristics as well as PSM were evaluated&#46; The statistical analyses of the collected data were conducted using SPSS 29&#46;0 &#40;Statistical Product and Service Solutions for Windows&#44; Version 29&#46;0&#44; IBM Corp&#46;&#44; Armonk&#44; NY&#44; U&#46;S&#46;&#44; 2023&#41; software package&#46; Parametric tests were used for the variables determined to conform to the normal distribution&#44; which were expressed as mean&#8239;&#177;&#8239;standard deviation &#40;SD&#41; values&#44; whereas non-parametric were used for the variables determined not to conform to the normal distribution&#44; which were expressed as median with interquartile range values&#46; Paired comparisons between the patient groups created based on the PSM and pathological T stages in terms of categorical and continuous pre-operative demographic&#44; radiological and laboratory variables were made using Pearson&#8217;s chi-squared or Fisher&#39;s exact tests and the independent samples <span class="elsevierStyleItalic">t</span>-test or the Man Withney <span class="elsevierStyleItalic">U</span> test&#44; respectively&#46; The optimal cut-off values of the independent variables in predicting PSM and pT3a upstaging were determined by the receiver operating characteristic &#40;ROC&#41; analysis&#46; Multivariable binary logistic regression analysis was used to determine the prognostic values of these variables in predicting PSM and pT3a upstaging&#46; The probability &#40;<span class="elsevierStyleItalic">p</span>&#41; statistics of &#8804; 0&#46;05 were deemed to indicate statistical significance&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0015" class="elsevierStylePara elsevierViewall">The mean age of 159 patients&#44; 68&#37; of whom were male&#44; included in the study sample was 57&#46;98 years&#46; Of these patients&#44; pT3a upstaging was detected in 32 &#40;20&#46;1&#37;&#41; patients &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; pT3a upstaging was detected in 27 and 5 patients who underwent open surgery and laparoscopic surgery&#44; respectively &#40;<span class="elsevierStyleItalic">P</span>&#8239;&#60;&#8239;&#46;001&#41;&#46; In addition&#44; pT3a upstaging was detected in 6 and 26 patients who underwent RN and PN&#44; respectively &#40;<span class="elsevierStyleItalic">P</span>&#8239;&#60;&#8239;&#46;001&#41;&#44; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; Tumor size in pT1 and pT3a patient groups was 3&#46;68 and 10&#46;87&#44; respectively&#46; There was a significant difference in tumor size between the two groups &#40;<span class="elsevierStyleItalic">P</span>&#8239;&#60;&#8239;&#46;001&#41;&#46; RNS was 6 and 8 in the pT1 and pT3a patient groups&#44; respectively &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; There was a significant difference in RNS between the two groups &#40;<span class="elsevierStyleItalic">P</span>&#8239;&#60;&#8239;&#46;001&#41;&#46; Peritumoral fatty tissue thickness was 11&#46;97&#8239;mm and 15&#46;38&#8239;mm in the pT1 and pT3a patient groups&#44; respectively &#40;<span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;022&#41;&#46; SII was 589&#46;58 and 893&#46;15 in pT1 and pT3a patient groups&#44; respectively &#40;<span class="elsevierStyleItalic">P</span>&#8239;&#60;&#8239;&#46;001&#41;&#46; DRR was 1&#46;08 and 1&#46;29 in the pT1 and pT3a patient groups&#44; respectively&#44; indicating a significant difference between the two groups &#40;<span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;048&#41;&#46; Sarcomatoid differentiation was significantly more frequent in the pT3a group than in the pT1 group &#40;<span class="elsevierStyleItalic">P</span>&#8239;&#60;&#8239;&#46;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46; Tumor size predicted pT3a upstaging with 100&#37; sensitivity and 98&#46;6&#37; specificity when its cut-off value was taken as 6&#46;85&#8239;mm &#40;AUC&#58; 1&#46;000&#44; <span class="elsevierStyleItalic">P</span>&#8239;&#60;&#8239;&#46;001&#41; in the ROC curve analysis&#46; In smaller tumor sizes&#44; it was determined that peritumoral fatty tissue HU&#44; as the parameter with the highest statistical significance&#44; predicted pT3a upstaging with 83&#46;3&#37; sensitivity and 74&#37; specificity when its cut-off value was taken as &#8722;87&#46;45 HU &#40;AUC&#58; 0&#46;861&#44; <span class="elsevierStyleItalic">P</span>&#8239;&#60;&#8239;&#46;001&#41;&#46; ROC analysis revealed that HU&#44; RNS&#44; and SII values of the tumor-side perirenal fat HU may statistically significantly predicted pT3a upstaging with lower sensitivity and specificity compared to the peritumoral fat HU &#40;<span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;001&#44; <span class="elsevierStyleItalic">P</span>&#8239;&#60;&#8239;&#46;001&#44; and <span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;001&#44; respectively&#41;&#46; Logistic regression analyses revealed that peritumoral fat HU &#40;&#60;&#8722;87&#46;44 HU vs&#46; &#8805;&#8722;87&#46;44 HU&#59; HR&#44; 16&#46;907&#59; 95&#37; CI&#58; 2&#46;958&#8211;96&#44;629 <span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;001&#41; may statistically significantly predict pT3a upstaging&#46; Additionally&#44; the RNS and the tumor side perirenal fat HU may significant pre-operative biomarkers for pT3a upstaging &#40;<span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;008 and <span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;015&#44; respectively&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">PSM was detected in 28 &#40;17&#46;6&#37;&#41; patients&#46; DRR was 1&#46;091 in the patient group with negative surgical margins after RCC surgery and 1&#46;271 in the PSM group&#46; There was a significant difference in DRR between the two groups &#40;<span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;024&#41;&#46; AAPR was 0&#46;0632 in the patient group with negative surgical margins after RCC surgery&#44; and 0&#46;0457 in the PSM group &#40;<span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;001&#41;&#46; ROC analysis indicated that AAPR predicted PSM with 70&#46;5&#37; sensitivity and 67&#46;9&#37; specificity when its cut-off value was taken as 0&#46;052 &#40;AUC&#58; 0&#46;696&#44; <span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;001&#41;&#46; In addition&#44; the prognostic values of age and DRR in predicting PSM were found to be statistically significant&#44; when their cut-off values were taken as 57&#46;5 and 1&#46;11&#44; respectively &#40;<span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;033 and <span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;039&#44; respectively&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>&#41;&#46; The results of the logistic regression analyses for pre-operative predictive factors for PSM and pT3a upstaging are shown in <a class="elsevierStyleCrossRef" href="#tbl0030">Table 6</a>&#46; Logistic regression analysis revealed that AAPR &#91;&#60;0&#46;052 vs &#8805;0&#46;052&#59; hazard ratio &#40;HR&#41;&#58; 5&#46;52&#59; 95&#37; latent range &#40;CI&#41;&#44; 2&#44;132&#8211;14&#46;301&#59; <span class="elsevierStyleItalic">P</span>&#8239;&#60;&#8239;&#46;001&#93; and DRR &#91;&#60;1&#46;1 vs &#8805;1&#46;1&#59; HR&#58; 3&#44;678&#59; 95&#37; CI&#58; 1&#46;386&#8211;9&#46;764 <span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;009&#93; may statistically significantly predict PSM&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><elsevierMultimedia ident="tbl0030"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0025" class="elsevierStylePara elsevierViewall">This study was carried out to investigate the biomarkers that can predict post-operative pT3a upstaging and PSM pre-operatively in patients with cT1 RCC&#46; The results of the study indicated that tumor size&#44; RNS&#44; peritumoral fatty tissue thickness&#44; HU values of peritumoral and tumor-side fatty tissues&#44; and SII value of tumor-side fatty tissue&#44; DRR statistically significantly predicted pT3a upstaging&#44; whereas DRR and AAPR statistically significantly may predict PSM&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">There is a number of studies in the literature on the factors that can predict pT3a upstaging&#46; In one of these studies&#44; Gorin et al&#46; evaluated a total of 1096 patients who had undergone robot-assisted PN and found that size and localization of the tumor statistically significantly predicted pT3a upstaging&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> However&#44; the fact that only patients who underwent PN were included in the study stands out as a limitation of the study&#46; In another conducted with 987 cT1 patients&#44; Jeong et al&#46; found that tumor size &#62;4&#8239;cm and a high Fuhrman grade statistically significantly predicted pT3a upstaging&#44; and type of operation had no effect on pT3a upstaging&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Patients who underwent PN and RN were included in our study&#46; It revealed that in addition to tumor size&#44; the type of operation may also have diagnostic value in predicting pT3a staging&#46; However&#44; we think that this is due to the difference between the radiological clinical stage and the pathological stage&#44; rather than the type and technique of the surgery&#46; The discrepancy between the results of this study and the relevant results of the said studies might be due to the fact that pre-operative staging might not have been performed accurately&#46; Ghanie et al&#46; reported older age&#44; male gender&#44; presence of comorbidities&#44; presence of cT1b tumors&#44; undergone RN&#44; and high Fuhrman grade statistically significantly predicted pT3a upstaging&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> Ramaswamy et al&#46; demonstrated that clear cell histology&#44; tumor size &#62;4&#8239;cm&#44; and PSM were the factors significantly associated with pT3a upstaging&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> Similarly&#44; this study&#8217;s findings also suggest that tumor size is significantly associated with pT3a upstaging&#46; Furthermore&#44; we think that the predictive value of tumor size may be lower in patients in clinically lower stages&#44; and that RNS may also predict pT3a upstaging pre-operatively in this patient group&#46; Along these lines&#44; Tay et al&#46; determined a significant relationship between RNS and upstaging in 65 patients with RCC who underwent RN&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> We think that RNS may be an important pre-operative predictor&#44; especially in patients who are scheduled to have PN due to small tumor size&#46; As a matter of fact&#44; fat invasion may not always be detectable during imaging when performing clinical staging for RCC&#46; Even in cases where the tumor is clinically small&#44; various events occur in the tumoral microenvironment that may affect cancer progression&#46; However&#44; the factors that can pre-operatively predict cancerization in the tumoral microenvironment are not yet understood&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> The results of this study also revealed that the HU value of the peritumoral fatty tissue and peritumoral fatty tissue thickness may statistically significantly predicted pT3a upstaging&#46; Therefore&#44; we think that these parameters can be used to differentiate the causes that may lead to septal thickening in the perirenal area&#44; and help to make a more accurate clinical staging and treatment planning&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">It has been shown in various studies that the increased SII predicts a poor prognosis after RCC surgery&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#44;16</span></a> In parallel&#44; the findings of this study indicated a significant correlation between the SII value and advanced T staging&#46; Taking into consideration the relationship between pathological upstaging and poor prognosis&#44; SII&#44; which is a cost-effective and easily reproducible biomarker&#44; can pre-operatively predict the prognosis after RCC surgery&#44; and may allow more closely follow-up of patients in the post-operative period&#46; Our study revealed that DRR and AAPR parameters may had diagnostic value in predicting preoperative PSM&#46; When we searched the literature&#44; we did not find any study about DRR and AAPR to predict PSM&#46; The fact that AST is elevated especially in glycolysis by malignant cells and ALT does not change&#44; has shown in some previous studies that DRR may be an important prognostic marker in malignancies such as lung colon breast cancer&#46;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17&#8211;19</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">While albumin provides cell growth and stabilization&#44; one of the most important antioxidants against carcinogenic substances&#46; Tumor cells can inhibit albumin secretion by secreting pro-inflammatory cytokines&#46; Low albumin levels can lower immunity&#44; resulting in a decreased anti-tumor effect&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> Albumin level is thought to have a survival effect in many cancer types&#44; including RCC&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> It has been reported that high ALP value is also an indicator of oxidative stress&#44; which is associated with tumor development&#46; ALP level has been found to be associated with survival in cancer types such as hepatocellular cancer&#44; gastric cancer&#44; and RCC&#46;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">22&#8211;25</span></a> The relationship between PSM and prognosis in patients with RCC is controversial&#46; Some studies argue that PSM affects the prognosis badly&#44; while some studies argue that it does not&#46;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">26&#44;27</span></a> We did not evaluate the prognosis of the patients in our study&#44; but we think that the ability of DRR and AAPR to detect PSM in the pre-operative period with high-proof studies to be conducted in the future may provide more information about the prognosis&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">As a result of our study&#44; tumor size&#44; RNS&#44; peritumoral fatty tissue thickness&#44; HU values of peritumoral and tumor-side fatty tissue and SII value of adipose tissue on the side of the tumor and DRR may statistically predict the pT3a upstage&#44; while DRR and AAPR may predict PSM statistically significant&#46; This may be beneficial in informing our patients about the prognosis and treatment options &#40;such as the need for additional treatment or strict follow-up&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> It may help the surgeon&#39;s decide on the operation type&#44; especially for the large tumors&#44; and reducing the anxiety of both the patient and the surgeon in the postoperative period&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Our study had several limitations&#46; First&#44; single center and the retrospective design of the study constituted limitation&#46; Secondly&#44; the surgeries were not performed by a single surgeon&#46; Thirdly&#44; although patients with inflammatory conditions that might have an effect on the neutrophil and lymphocyte counts were excluded from the study&#44; it is possible that patients with other unknown conditions that could affect neutrophil and lymphocyte counts were included in the study&#46; Fourthly&#44; there is no established standard cut-off value for SII in the literature&#44; therefore&#44; we determined the cut-off value of SII ourselves&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusion</span><p id="par0055" class="elsevierStylePara elsevierViewall">The findings of this study indicated that tumor size&#44; RNS value&#44; peritumoral fatty tissue thickness&#44; HU values of peritumoral and tumor side fatty tissues&#44; DRR&#44; SII values can predict pT3a upstaging of patients with cT1 RCC&#44; and that AAPR and DRR values can predict PSM&#46; Accordingly&#44; we think that these biomarkers can be used in various scoring systems to predict important pathological outcomes such as upstaging and PSM&#44; and may provide guidance for the surgeon especially in cases where may not be able to decide on the surgical technique due to presence of large-scale tumors&#44; provided that the findings of this study are corroborated by the findings of future large-scale studies&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Funding</span><p id="par0060" class="elsevierStylePara elsevierViewall">None&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Ethics approval and consent to participate</span><p id="par0065" class="elsevierStylePara elsevierViewall">The study protocol was approved by the institutional ethics committee prior to the conduct of the study&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflict of interests</span><p id="par0070" class="elsevierStylePara elsevierViewall">The authors declare that they have no potential conflict of interest regarding the investigation&#44; authorship&#44; and&#47;or publication of this article&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">CRediT authorship contribution statement</span><p id="par0075" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">G&#46; &#199;il&#58;</span> Conceptualization&#44; Data curation&#44; Formal analysis&#44; Funding acquisition&#44; Investigation&#44; Methodology&#44; Project administration&#44; Resources&#44; Software&#44; Validation&#44; Visualization&#44; Writing &#8211; original draft&#44; Writing &#8211; review &#38; editing&#46; <span class="elsevierStyleBold">M&#46; Yilmaz&#58;</span> Conceptualization&#44; Funding acquisition&#44; Investigation&#44; Methodology&#44; Resources&#44; Software&#44; Validation&#44; Writing &#8211; review &#38; editing&#46; <span class="elsevierStyleBold">Y&#46; Sahin&#58;</span> Data curation&#44; Funding acquisition&#44; Investigation&#44; Resources&#44; Software&#44; Validation&#44; Writing &#8211; review &#38; editing&#46; <span class="elsevierStyleBold">&#304;&#46; Ulus&#58;</span> Data curation&#44; Formal analysis&#46; <span class="elsevierStyleBold">&#304;&#46;O&#46; Can&#305;tez&#58;</span> Conceptualization&#44; Funding acquisition&#46; <span class="elsevierStyleBold">&#304;&#46;E&#46; Kand&#305;ral&#305;&#58;</span> Methodology&#44; Project administration&#46;</p></span></span>"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objectives</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">The objective of this study is predict positive surgical margin &#40;PSM&#41; and pathological T3a &#40;pT3a&#41; upstaging in patients with clinical T1 &#40;cT1&#41; renal cell carcinoma &#40;RCC&#41;&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Materials and methods</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">159 patients who underwent radical nephrectomy &#40;RN&#41; or partial nephrectomy &#40;PN&#41; for RCC&#46; Patients&#8217; demographic&#44; laboratory&#44; radiological and pathological data that could predict PSM and pT3a upstaging pre-operatively were evaluated&#46; The categorical and continuous variables were compared between the patient groups with or without PSM and&#47;or pT3a upstaging using Pearson&#8217;s chi-square test&#44; and independent samples <span class="elsevierStyleItalic">t</span>-test or the Mann-Whitney U test&#44; respectively&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">PT3a upstaging was detected in 32 &#40;20&#46;1&#37;&#41; patients&#44; and PSM was detected in 28 &#40;17&#46;6&#37;&#41; patients&#46; PT3a upstaging was detected in 27 and 5 patients who underwent open surgery and laparoscopic surgery&#44; respectively &#40;<span class="elsevierStyleItalic">P</span>&#8239;&#60;&#8239;&#46;001&#41;&#46; In addition&#44; pT3a upstaging was detected in 6 and 26 patients who underwent RN and PN&#44; respectively &#40;<span class="elsevierStyleItalic">P</span>&#8239;&#60;&#8239;&#46;001&#41;&#46; Peritumoral fatty tissue thickness was 11&#46;97 and 15&#46;38 in the pT1 and pT3a patient groups&#44; respectively &#40;<span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;022&#41;&#46; In patients with pT3a upstaging&#44; tumor size was larger&#44; and renal nephrometry score and systemic immune-inflammation index &#40;SII&#41; were higher &#40;<span class="elsevierStyleItalic">P</span>&#8239;&#60;&#8239;&#46;001&#44; <span class="elsevierStyleItalic">P</span>&#8239;&#60;&#8239;&#46;001&#44; and <span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;022&#44; respectively&#41;&#46; It was determined that De Ritis ratio &#40;DRR&#41; and albumin-to-alkaline phosphatase &#40;ALP&#41; ratio &#40;AAPR&#41; parameters had significant prognostic values in predicting PSM &#40;<span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;024&#44; and <span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;001&#44; respectively&#41;&#46; ROC analysis indicated that tumor size predicted pT3a upstaging with 100&#37; sensitivity and 98&#46;6&#37; specificity when its cut-off value was taken as 6&#46;85&#8239;mm &#40;AUC&#58; 1&#46;000&#44; <span class="elsevierStyleItalic">P</span>&#8239;&#60;&#8239;&#46;001&#41;&#46; In addition&#44; logistic regression analysis revealed AAPR and DRR as significant predictors of PSM &#40;<span class="elsevierStyleItalic">P</span>&#8239;&#60;&#8239;&#46;001&#44; and <span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;009&#44; repsectively&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">The findings of this study indicated that the surgical technique of choice and the type of operation&#44; tumor size&#44; RNS value&#44; peritumoral fatty tissue thickness&#44; HU values of peritumoral and tumor side fatty tissues&#44; and DRR and SII values can predict pT3a upstaging of patients with cT1 RCC&#44; and that AAPR and DRR values can predict PSM&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objectives"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Materials and methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusion"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivos</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">El objetivo del presente estudio es establecer par&#225;metros que permitan predecir la afectaci&#243;n de los m&#225;rgenes quir&#250;rgicos &#40;MQP&#41; y la elevaci&#243;n de estadio cl&#237;nico T1 &#40;cT1&#41; a estadio patol&#243;gico T3a &#40;pT3a&#41; en pacientes con carcinoma de c&#233;lulas renales &#40;CCR&#41;&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Materiales y m&#233;todos</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Un total de 159 pacientes fueron sometidos a nefrectom&#237;a radical &#40;NR&#41; o nefrectom&#237;a parcial &#40;NP&#41; por CCR&#46; En el periodo preoperatorio&#44; se evaluaron los datos demogr&#225;ficos&#44; los hallazgos de laboratorio y los resultados radiol&#243;gicos y anatomopatol&#243;gicos que pod&#237;an ser factores predictores de MQP y del incremento a estadio pT3a&#46; Las variables categ&#243;ricas y continuas se compararon entre los grupos de pacientes con o sin MQP y&#47;o incremento a estadio pT3a mediante la prueba chi-cuadrado de Pearson y la prueba t de muestras independientes o la prueba U de Mann-Whitney&#44; respectivamente&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Se detect&#243; un aumento a estadio pT3a en 32 &#40;20&#44;1&#37;&#41; pacientes&#44; y MQP en 28 &#40;17&#44;6&#37;&#41; pacientes&#46; De los pacientes reestadificados a pT3&#44; 27 fueron sometidos a cirug&#237;a abierta y 5 a cirug&#237;a laparosc&#243;pica &#40;<span class="elsevierStyleItalic">P</span>&#8239;&#60;&#8239;&#44;001&#41;&#46; Adem&#225;s&#44; de los pacientes reestadificados a pT3a&#44; 6 fueron sometidos a NR y 26 a NP &#40;<span class="elsevierStyleItalic">P</span>&#8239;&#60;&#8239;&#44;001&#41;&#46; El grosor del tejido adiposo peritumoral fue de 11&#44;97 y 15&#44;38 en los grupos de pacientes con pT1 y pT3a&#44; respectivamente &#40;<span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#44;022&#41;&#46; En los pacientes con aumento a estadio pT3a ten&#237;an un tama&#241;o del tumor mayor&#44; y la puntuaci&#243;n del RENAL score &#40;RNS&#41; y el &#237;ndice de inmunidad-inflamaci&#243;n sist&#233;mica &#40;IIS&#41; eran m&#225;s elevados &#40;<span class="elsevierStyleItalic">P</span>&#8239;&#60;&#8239;&#44;001&#44; <span class="elsevierStyleItalic">P</span>&#8239;&#60;&#8239;&#44;001 y <span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#44;022&#44; respectivamente&#41;&#46; Se determin&#243; que la relaci&#243;n AST&#47;ALT &#40;De Ritis&#44; DRR&#41; y la relaci&#243;n alb&#250;mina&#47;fosfatasa alcalina &#40;A&#47;FA&#41; ten&#237;an un valor pron&#243;stico significativo en la predicci&#243;n de MQP &#40;<span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#44;024&#44; y <span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#44;001&#44; respectivamente&#41;&#46; Seg&#250;n el an&#225;lisis ROC&#44; el tama&#241;o del tumor predijo el incremento a estadio a pT3a con una sensibilidad del 100&#37; y una especificidad del 98&#44;6&#37; cuando su valor de corte fue de 6&#44;85&#8239;mm &#40;AUC&#58; 1&#44;000&#44; <span class="elsevierStyleItalic">P</span>&#8239;&#60;&#8239;&#44;001&#41;&#46; Adem&#225;s&#44; el an&#225;lisis de regresi&#243;n log&#237;stica revel&#243; que A&#47;FA y DRR eran predictores significativos de MQP &#40;<span class="elsevierStyleItalic">P</span>&#8239;&#60;&#8239;&#44;001&#44; y <span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#44;009&#44; respectivamente&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Los resultados de este estudio indicaron que la t&#233;cnica quir&#250;rgica elegida y el tipo de intervenci&#243;n&#44; el tama&#241;o del tumor&#44; el valor de RNS&#44; el grosor del tejido adiposo peritumoral&#44; las UH del tejido adiposo peritumoral y perirrenal&#44; y los valores de DRR e IIS pueden predecir el incremento de estadio cT1 a estadio pT3a en los pacientes con CCR&#44; y que los valores de A&#47;FA y DRR pueden predecir los MQP&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Objetivos"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Materiales y m&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusi&#243;n"
          ]
        ]
      ]
    ]
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        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0005"
            "detalle" => "Table "
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                  \t\t\t\t">108 &#40;68&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Upper&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Technique of Surgery &#40;n&#44; &#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Laparoscopic&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Radical&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">75 &#40;52&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Partial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">84 &#40;47&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Pathological stage &#40;n&#44; &#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>pT1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">127 &#40;79&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>pT3a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32 &#40;20&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Surgical margin &#40;n&#44; &#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">131 &#40;82&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Positive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28 &#40;17&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Comorbidity present &#40;n&#44; &#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>HT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70 &#40;44&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">DM</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38 &#40;23&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">CAD</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 &#40;11&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">CVE &#40;SVO&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;1&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">ASA score &#40;n&#44; &#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">84 &#40;52&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47 &#40;29&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27 &#40;16&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;0&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
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            "identificador" => "at0010"
            "detalle" => "Table "
            "rol" => "short"
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            0 => array:2 [
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Parameters&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Negative Surgical Margin &#40;n&#8239;&#61;&#8239;131&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Positive Surgical Margin &#40;n&#8239;&#61;&#8239;28&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span> value&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">pT1 &#40;n&#8239;&#61;&#8239;127&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">pT3a &#40;n&#8239;&#61;&#8239;32&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span> value&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Gender &#40;n&#44; &#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;788&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;640&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">90 &#40;56&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 &#40;11&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">88 &#40;55&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20 &#40;12&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41 &#40;25&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;6&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39 &#40;24&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;7&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Side &#40;n&#44; &#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">19 &#40;11&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">84 &#40;27&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">26 &#40;16&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Parameters&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Negative Surgical Margin &#40;n&#8239;&#61;&#8239;131&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Positive Surgical Margin &#40;n&#8239;&#61;&#8239;28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">pT1 &#40;n&#8239;&#61;&#8239;127&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">pT3a &#40;n&#8239;&#61;&#8239;32&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span> value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Age&#44; year &#40;Mean&#44; SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55&#44;77 &#40;11&#44;97&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60&#44;82 &#40;10&#44;42&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">&#44;02</span></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56&#44;46 &#40;11&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57&#44;47 &#40;13&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#44;334&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tumor Diameter &#40;mm&#41; &#40;mean&#44; SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;3&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;7 &#40;4&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;194&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;68 &#40;1&#44;27&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#44;87 &#40;2&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">&#60;&#46;001</span></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Likelihood of major complication &#40;median&#44; range&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;4 &#40;6&#46;4&#8211;21&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;4 &#40;6&#46;4&#8211;11&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#44;72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;40 &#40;6&#44;4&#8211;21&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#44;1 &#40;6&#44;4&#8211;21&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">&#60;&#46;001</span></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RNS &#40;Mean&#44; SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;25 &#40;1&#44;68&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;53 &#40;1&#44;83&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#44;213&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;1&#44;52&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;1&#44;52&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">&#60;&#46;001</span></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Peritumoral Fat thickness &#40;mm&#41; &#40;Mean&#44; SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#44;49 &#40;6&#44;63&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#44;39 &#40;5&#44;65&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#44;313&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#44;97 &#40;6&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#44;38 &#40;6&#44;94&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">&#44;022</span></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Peritumoral Fat HU &#40;median&#44; range&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;89&#44;5 &#40;&#8722;116 to &#8722;36&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;90 &#40;&#8722;97 to &#8722;35&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#44;987&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">DRR &#40;Mean&#44; SD&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sarcomatoid differantiation&#43;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>LVI&#43;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>PNI&#43;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">&#60;0&#46;001</span></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Predictive parameters for surgical margine positivity&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Cut-off value&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;052&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;696 &#40;0&#44;584&#8211;0&#44;808&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;625 &#40;0&#44;515&#8211;0&#44;734&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">RNS&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">6&#44;5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">77&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">64&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;780 &#40;0&#44;677&#8211;0&#44;884&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60;&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Tumor Diameter&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">100&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">98&#44;6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;000 &#40;0&#44;998&#8211;1&#44;000&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Peritumoral Fat HU&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;87&#44;45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">83&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">74&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;861 &#40;0&#44;769&#8211;0&#44;953&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60;&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Tumor Side Perirenal Fat HU&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;94&#44;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">72&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">76&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;758 &#40;0&#44;627&#8211;0&#44;889&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;132&#8211;14&#44;301&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Age &#40;&#60;57&#44;5 vs&#46; &#8805;57&#44;5 year&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">&#46;009</span></span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Peri-tumoral Fat HU &#40;&#60;&#8722;87&#44;44 vs&#46; &#8805;87&#44;44&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">&#44;001</span></span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">RENAL nephrometry score &#40;&#60;6&#44;51 vs&#46; &#8805;6&#44;51&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">DRR &#40;&#60;1&#44;11 vs&#46; &#8805;1&#44;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">1&#44;644&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Tumor Side Perirenal Fat HU &#40;&#60;&#8722;94&#44;14 vs&#46; &#8805;&#8722;94&#44;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                      "titulo" => "Global cancer statistics 2018&#58; GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries"
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                            0 => "F&#46; Bray"
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                            2 => "I&#46; Soerjomataram"
                            3 => "R&#46;L&#46; Siegel"
                            4 => "L&#46;A&#46; Torre"
                            5 => "A&#46; Jemal"
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                      "titulo" => "The 2016 WHO Classification of Tumours of the Urinary System and Male Genital Organs-Part A&#58; renal&#44; penile&#44; and testicular tumours"
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                      "doi" => "10.1016/j.eururo.2016.02.029"
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