Zhang Zhong-Yuan, Tang Qi, Li Xue-Song, Zhang Qian, Mayer Wesley A, Wu Jing-Yun, Yang Xue-Dong, Zhang Xiao-Chun, Wang Xiao-Ying, Zhou Li-Qun
Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center.
Int J Urol. 2014 Jan;21(1):40-4. doi: 10.1111/iju.12192. Epub 2013 May 15.
To investigate the clinical significance of preoperative aspects and dimensions used for anatomic (PADUA) and radius exophytic/endophytic nearness anterior/posterior location (RENAL) scoring systems for renal neoplasms in patients undergoing laparoscopic partial nephrectomy.
A retrospective analysis was carried out on clinical data of 245 Chinese patients with renal neoplasms undergoing laparoscopic partial nephrectomy from June 2008 to June 2012. The perioperative complications and variables, as well as PADUA and RENAL score, were compared.
The PADUA and RENAL scoring systems were significantly associated with percent change in estimated glomerular filtration rate (P = 0.032 and P = 0.026 respectively), whereas the RENAL scoring system was also significantly associated with warm ischemia time (P = 0.032). On multivariate analysis, both scores were able to predict percent change in estimated glomerular filtration rate (PADUA, P = 0.011; RENAL, P = 0.028). There were no significant associations between the two scoring systems assessed and the occurrence of complications or tumor stage. The correlation between PADUA classification and RENAL nephrometry score was significant (P < 0.0001). Fleiss' generalized kappa was 0.69-0.89 for the various components of the PADUA score and 0.67-0.89 for the RENAL nephrometry components.
The PADUA classification and RENAL nephrometry score are comprehensive assessment tools for delineating renal tumor anatomy. The reproducibility of the PADUA and RENAL scores is substantial, but further research is required to evaluate its performance in more accurately predicting operative and patient-related outcomes.
探讨术前解剖学（PADUA）评分系统及肾肿瘤外生性/内生性与前后位置关系（RENAL）评分系统在接受腹腔镜部分肾切除术患者中对肾肿瘤评估的临床意义。
对2008年6月至2012年6月期间接受腹腔镜部分肾切除术的245例中国肾肿瘤患者的临床资料进行回顾性分析。比较围手术期并发症、变量以及PADUA和RENAL评分。
PADUA和RENAL评分系统与估计肾小球滤过率的变化百分比显著相关（分别为P = 0.032和P = 0.026），而RENAL评分系统也与热缺血时间显著相关（P = 0.032）。多因素分析显示，两个评分系统均能够预测估计肾小球滤过率的变化百分比（PADUA，P = 0.011；RENAL，P = 0.028）。所评估的两个评分系统与并发症的发生或肿瘤分期之间无显著关联。PADUA分类与RENAL肾计量评分之间的相关性显著（P < 0.0001）。PADUA评分各组成部分的Fleiss广义kappa值为0.69 - 0.89，RENAL肾计量各组成部分的Fleiss广义kappa值为0.67 - 0.89。
PADUA分类和RENAL肾计量评分是描述肾肿瘤解剖结构的综合评估工具。PADUA和RENAL评分具有较高的可重复性，但需要进一步研究以评估其在更准确预测手术及患者相关结局方面的性能。
