University of Kentucky, Lexington, Kentucky 40536, USA.
J Urol. 2012 Nov;188(5):1684-9. doi: 10.1016/j.juro.2012.07.043. Epub 2012 Sep 19.
Multiple scoring systems have been proposed to standardize the description of anatomical features of renal tumors. However, it remains unclear which of these systems, if any, is most useful, or whether any performs better than simply reporting tumor size or location in patients undergoing partial nephrectomy. To clarify these issues we evaluated the association of tumor size, location, R.E.N.A.L. (Radius/Exophytic/Nearness to collecting system/Anterior/Location), PADUA (Preoperative Aspects and Dimensions Used for an Anatomical classification) and centrality index scores with perioperative outcomes.
Patients undergoing partial nephrectomy with available preoperative imaging were identified from 2005 to 2011. R.E.N.A.L., PADUA and centrality index scores were assigned according to the described protocols for those systems. Associations between each variable and ischemia time, estimated blood loss, total operative time and change in estimated glomerular filtration rate were examined.
A total of 162 patients were identified with a median tumor size of 3.1 cm (IQR 2.2 to 4.6). Median estimated blood loss, ischemia time and total operative time were 200 ml (IQR 100 to 300), 24 minutes (IQR 20 to 30) and 211 minutes (IQR 179 to 249), respectively. Each scoring system was found to have a statistically significant (p <0.001) correlation with ischemia time, with the centrality index system showing the strongest correlation. Furthermore, each of the scoring systems showed a stronger correlation with ischemia time than tumor size or tumor location.
Each scoring system outperformed tumor size and location, and may be useful when describing the surgical complexity of renal tumors treated with partial nephrectomy.
已经提出了多种评分系统来规范描述肾肿瘤的解剖特征。然而，目前尚不清楚这些系统中是否有任何一个系统最有用，或者是否有任何一个系统比仅仅报告接受部分肾切除术的患者的肿瘤大小或位置更有效。为了阐明这些问题，我们评估了肿瘤大小、位置、R.E.N.A.L.（半径/外生性/靠近集合系统/前位/位置）、PADUA（术前方面和用于解剖分类的尺寸）和中心性指数评分与围手术期结果的相关性。
从 2005 年至 2011 年，确定了有可用术前影像学资料的接受部分肾切除术的患者。根据这些系统的描述方案，为患者分配 R.E.N.A.L.、PADUA 和中心性指数评分。检查了每个变量与缺血时间、估计失血量、总手术时间和估算肾小球滤过率变化之间的相关性。
共确定了 162 例患者，肿瘤中位数为 3.1cm（IQR 2.2 至 4.6）。中位数估计失血量、缺血时间和总手术时间分别为 200ml（IQR 100 至 300）、24 分钟（IQR 20 至 30）和 211 分钟（IQR 179 至 249）。每个评分系统与缺血时间均具有统计学显著相关性（p<0.001），其中中心性指数系统相关性最强。此外，每个评分系统与缺血时间的相关性均强于肿瘤大小或肿瘤位置。
每个评分系统均优于肿瘤大小和位置，在描述接受部分肾切除术治疗的肾肿瘤的手术复杂性时可能有用。
