Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Los Angeles, CA, USA.
Department of Radiology, University of Southern California, Los Angeles, CA, USA.
Eur Urol. 2014 Nov;66(5):884-93. doi: 10.1016/j.eururo.2014.03.010. Epub 2014 Mar 19.
The contact surface area (CSA) of a tumor with adjacent renal parenchyma may determine the complexity and thus the perioperative outcomes of partial nephrectomy (PN).
We devised a novel imaging parameter, renal tumor CSA, and correlate it with perioperative outcomes in patients undergoing PN.
DESIGN, SETTING, AND PARTICIPANTS: Of 200 patients undergoing PN for a tumor (January 2010 to August 2011), 162 had renal protocol computed tomography scanning data available. CSA was calculated using image-rendering software (Synapse 3D, Fujifilm), and interobserver variability was determined between three independent observers.
CSA was correlated to baseline demographics and perioperative outcomes as a continuous and categorical variable using multivariable logistic regression analysis. The ability of CSA to predict adverse perioperative events was compared with demographic factors and nephrometry scoring systems.
The mean tumor size was 3.1cm; CSA was 18.3 cm(2). CSA ≥20 cm(2) correlated with adverse tumor characteristics (greater tumor size, volume, and complexity) and perioperative outcomes (more parenchymal volume loss, blood loss, and complications) compared with CSA <20 cm(2). On multivariable logistic regression, CSA independently predicted operative time, complications, hospital stay, and renal functional outcomes. This predictive ability of CSA was superior to the other parameters evaluated.
CSA is a novel imaging parameter that quantifies the CSA of renal tumor with adjacent parenchyma. Our preliminary data indicate that CSA correlates with PN outcomes. If validated externally in a larger cohort, CSA could be incorporated into future versions of nephrometry scoring systems.
In this study we outline the method of calculating the contact surface area (CSA) of renal tumors with the surrounding normal kidney using image-rendering software. We found that CSA correlates with a number of important surgical outcomes including operative time, loss of renal function, and complications.
肿瘤与毗邻肾实质的接触表面积（CSA）可能决定部分肾切除术（PN）的复杂性，进而影响围手术期结果。
我们设计了一种新的影像学参数，即肿瘤肾实质接触表面积（CSA），并将其与接受 PN 的患者的围手术期结果相关联。
设计、地点和参与者：在 2010 年 1 月至 2011 年 8 月期间，200 例接受 PN 治疗的肿瘤患者中，有 162 例有肾脏协议 CT 扫描数据可用。使用图像渲染软件（Synapse 3D，富士胶片）计算 CSA，并由三位独立观察者确定观察者间变异性。
CSA 与基线人口统计学和围手术期结果作为连续和分类变量进行多变量逻辑回归分析。将 CSA 预测不良围手术期事件的能力与人口统计学因素和肾肿瘤评分系统进行比较。
肿瘤的平均大小为 3.1cm；CSA 为 18.3cm2。与 CSA<20cm2 相比，CSA≥20cm2 与肿瘤的不良特征（更大的肿瘤大小、体积和复杂性）和围手术期结果（更多的肾实质体积丢失、出血量和并发症）相关。多变量逻辑回归分析表明，CSA 独立预测手术时间、并发症、住院时间和肾功能结果。CSA 的这种预测能力优于其他评估参数。
CSA 是一种新的影像学参数，可量化肿瘤与毗邻肾实质的接触表面积。我们的初步数据表明 CSA 与 PN 结果相关。如果在更大的队列中进行外部验证，CSA 可以被纳入未来的肾肿瘤评分系统版本中。
在这项研究中，我们概述了使用图像渲染软件计算肾肿瘤与周围正常肾脏接触表面积（CSA）的方法。我们发现 CSA 与许多重要的手术结果相关，包括手术时间、肾功能丧失和并发症。
