Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida 33612, USA.
J Urol. 2012 Sep;188(3):729-35. doi: 10.1016/j.juro.2012.04.115. Epub 2012 Jul 20.
We evaluated the ability of renal tumor complexity, as assessed by the R.E.N.A.L. (radius, exophytic, nearness to collecting system, anterior/posterior and location) nephrometry scoring system, to predict the functional efficacy of nephron sparing surgery.
We evaluated 42 patients who presented with an anatomically (32) or a functionally (10) solitary kidney and underwent partial nephrectomy. Each renal unit was assigned a R.E.N.A.L. nephrometry score using preoperative imaging. The CKD-EPI equation was applied to calculate the estimated glomerular filtration rate. The difference between the estimated glomerular filtration rate at baseline and at postoperative time points served as a measurement of the renal functional loss attributable to partial nephrectomy.
In the 42 patients who underwent partial nephrectomy the mean preoperative estimated glomerular filtration rate was 61.5 ml/minute/1.73 m(2). The median total nephrometry score was 8 (range 4 to 10). In the immediate postoperative period the cohort mean estimated glomerular filtration rate of 48.6 ml/minute/1.73 m(2) was significantly less than the preoperative value (p <0.0001). At 6-month followup the mean estimated glomerular filtration rate had recovered at 54.1 ml/minute/1.73 m(2) but it remained significantly less than the preoperative value (p = 0.0002). We noted no relationship between the postoperative decrease in the estimated glomerular filtration rate and the assigned total nephrometry score or in any individual component of the R.E.N.A.L. scoring system related to the targeted lesion.
Neither the individual components of the R.E.N.A.L. nephrometry scoring system nor the total nephrometry score predicted the realized functional loss, as assessed by the estimated glomerular filtration rate in patients with a solitary kidney treated with nephron sparing surgery. However, nephron sparing surgery was quite efficacious for preserving renal function since only a durable 11.6% decrease was noted in the estimated glomerular filtration rate.
我们评估了肾脏肿瘤复杂性（通过 R.E.N.A.L. 评分系统评估，包括半径、外生性、接近集合系统、前后和位置）预测保肾手术肾功能效果的能力。
我们评估了 42 名患有解剖学（32 名）或功能学（10 名）孤立肾的患者，并接受了部分肾切除术。使用术前成像对每个肾脏单位进行 R.E.N.A.L. 肾切除术评分。应用 CKD-EPI 方程计算估算肾小球滤过率。将基线时和术后时间点的估算肾小球滤过率之间的差异作为部分肾切除术后归因于肾功能丧失的测量。
在接受部分肾切除术的 42 名患者中，平均术前估算肾小球滤过率为 61.5 ml/min/1.73 m²。中位总肾切除术评分 8 分（范围 4 至 10 分）。在术后即刻，该队列的平均估算肾小球滤过率为 48.6 ml/min/1.73 m²，明显低于术前值（p<0.0001）。在 6 个月随访时，平均估算肾小球滤过率恢复至 54.1 ml/min/1.73 m²，但仍明显低于术前值（p=0.0002）。我们没有发现术后估算肾小球滤过率下降与总肾切除术评分或与目标病变相关的 R.E.N.A.L. 评分系统的任何单个成分之间存在关系。
在接受保肾手术治疗的孤立肾患者中，R.E.N.A.L. 肾切除术评分系统的单个成分或总肾切除术评分均不能预测肾小球滤过率评估的实际功能丧失。然而，保肾手术对于保护肾功能非常有效，因为估算肾小球滤过率仅出现了 11.6%的持久下降。
