The Arthur Smith Institute for Urology, Hofstra North Shore-LIJ School of Medicine, North Shore Long Island Jewish Health System, New Hyde Park, New York 11042, USA.
J Endourol. 2011 Dec;25(12):1921-4. doi: 10.1089/end.2011.0301. Epub 2011 Sep 9.
The centrality-index (C-Index), preoperative aspects and dimensions used for anatomic (P.A.D.U.A.) classification, and radius.exophyic/endophytic.nearness.anterior/posterior.location (R.E.N.A.L.) nephrometry schemes were developed as standardized scoring systems (SS) to quantify anatomic characteristics of kidney tumors. The objective of this study was to establish reliability and assess relationships between these three SS and perioperative and postoperative variables.
A retrospective chart review was performed in 101 patients who underwent laparoscopic partial nephrectomy. The nephrometry schemes were correlated with intraoperative and postoperative parameters using Spearman correlations. In addition, interobserver reliability was assessed on 50 of the patients by interclass correlations comparing the scores assigned by two residents and one fellow who reviewed preoperative CT studies of these patients.
The interobserver correlation was 0.84 for the C-Index, 0.81 for the P.A.D.U.A., and 0.92 for the R.E.N.A.L. scoring systems, demonstrating excellent interobserver reliability. All three SS were significantly associated with warm ischemia time (WIT) (C-Index, P=-0.44; P.A.D.U.A., P=0.25; R.E.N.A.L., P=0.32) and percent change in creatinine level (C-Index, P=- 0.33; P.A.D.U.A., P=0.37; R.E.N.A.L., P=0.37). There were no significant associations between any of the three SS assessed and the occurrence of complications, operative time, or estimated blood loss. No significant correlation was found between the P.A.D.U.A. and R.E.N.A.L. SS and length of stay; however, C-Index did show a significant relationship for patients with lower scores having longer hospital stays (P=-0.21).
All three scoring systems demonstrated reliability among observers and represent novel methods of quantitatively describing renal tumors. They were all associated with WIT, percent change in creatinine level, and tumor size. They did not, however, correlate with any other perioperative parameters investigated. At this time, these SS provide a common language for describing renal tumors.
中央指数（C-Index）、用于解剖学（P.A.D.U.A.）分类的术前方面和维度以及基于半径的外生性/内生性/远近/前后位置（R.E.N.A.L.）肾肿瘤测量方案被开发为标准化评分系统（SS），用于量化肾肿瘤的解剖特征。本研究的目的是建立这些 SS 的可靠性，并评估它们与围手术期和术后变量之间的关系。
对 101 例行腹腔镜肾部分切除术的患者进行了回顾性图表审查。使用 Spearman 相关性分析将肾肿瘤测量方案与术中及术后参数进行相关分析。此外，通过比较两位住院医师和一位研究员对这 50 名患者的术前 CT 研究评分，评估了 50 名患者的观察者间可靠性。
C-Index 的观察者间相关性为 0.84，P.A.D.U.A.的为 0.81，R.E.N.A.L.的为 0.92，表明观察者间的可靠性良好。所有三个 SS 均与热缺血时间（WIT）显著相关（C-Index，P=-0.44；P.A.D.U.A.，P=0.25；R.E.N.A.L.，P=0.32），与肌酐水平变化百分比也显著相关（C-Index，P=-0.33；P.A.D.U.A.，P=0.37；R.E.N.A.L.，P=0.37）。没有一个 SS 与并发症、手术时间或估计失血量之间存在显著相关性。在评估的三个 SS 中，没有一个与住院时间之间存在显著相关性；然而，C-Index 确实显示得分较低的患者住院时间更长（P=-0.21）。
所有三个评分系统在观察者之间均具有可靠性，代表了定量描述肾肿瘤的新方法。它们都与 WIT、肌酐水平变化百分比和肿瘤大小相关。然而，它们与任何其他研究的围手术期参数均无相关性。目前，这些 SS 为描述肾肿瘤提供了一种通用语言。
