Department of Radiology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.
Eur Radiol. 2013 Jan;23(1):280-6. doi: 10.1007/s00330-012-2582-3. Epub 2012 Jul 16.
To examine pre-operative imaging parameters that predict the residual amount of healthy renal parenchyma after nephron sparing surgery (NSS) for renal tumours, as this can help stratify patients towards the optimal surgical choice.
Ninety-eight patients with the diagnosis of a solitary unilateral renal tumour and with pre- and post-operative imaging were included in this retrospective study. Imaging, patient and surgical parameters were acquired and their correlation to the percentage decrease of healthy renal parenchyma following surgery was statistically examined to find the most significant predictor of nephron sparing.
Loss of healthy renal parenchyma was highest in patients with renal sinus tumour involvement (P = 0.003) and anterior tumours (P = 0.006), but not significantly correlated with medial/lateral location (P = 0.940) or exophytic/endophytic tumour growth (P = 0.244). The correlation of tumour size with the percentage of parenchymal sparing did not quite reach statistical significance (P = 0.053), but involvement of the urinary collecting system (P = 0.008) was a very good predictor of complications. Loss of healthy renal parenchyma was higher in patients with high-grade surgical complications (P = 0.001).
Several pre-operative parameters correlate to percentage nephron sparing after NSS. Anterior tumour location and renal sinus involvement proved to be the best predictors of loss of healthy renal parenchyma.
探讨保肾手术（NSS）后预测肾肿瘤患者保留健康肾实质量的术前影像学参数，以便为患者选择最佳手术方案提供帮助。
本回顾性研究纳入了 98 例单侧单发肾肿瘤患者，对其术前和术后的影像学、患者和手术参数进行了采集，并对其与术后健康肾实质减少百分比的相关性进行了统计学分析，以寻找保肾的最显著预测因子。
肾窦受累（P=0.003）和前位肿瘤（P=0.006）患者的健康肾实质丧失最高，但与中/侧位（P=0.940）或外生/内生肿瘤生长（P=0.244）无显著相关性。肿瘤大小与实质保留率的相关性尚未达到统计学意义（P=0.053），但尿收集系统受累（P=0.008）是并发症的一个很好的预测因子。高分级手术并发症患者的健康肾实质丢失更高（P=0.001）。
术前的几个参数与 NSS 后肾单位保留率相关。前位肿瘤位置和肾窦受累被证明是健康肾实质丢失的最佳预测因子。
