Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, People's Republic of China.
Department of Radiology, Changhai Hospital, Second Military Medical University, Shanghai, People's Republic of China.
Urology. 2014 May;83(5):1075-9. doi: 10.1016/j.urology.2014.01.019.
To evaluate the association of tumor size, renal nephrometry systems (RNSs), including RENAL, centrality index (C-index), preoperative aspects and dimensions used for anatomical, and diameter-axial-polar scoring, and individual categories of these RNSs with warm ischemia time (WIT).
A single surgeon's series of robotic partial nephrectomy patients for whom RNS was available were identified from 2012 to 2013. Spearman's correlation was used to evaluate associations between the RNSs and individual categories and WIT.
Analysis was performed based on 69 patients with a median tumor size of 3.5 cm (interquartile range 2.6-4.2). Overall, each scoring system and tumor size were found to have a statistically significant association with the WIT, with the C-index system exhibiting the strongest correlation (coefficient: -0.609, P <.001), which was confirmed in the series beyond the surgeon's learning curve. In the subgroup of relatively small renal masses (<3 cm), there was a statistically significant association between the C-index, preoperative aspects and dimensions used for anatomical, and diameter-axial-polar systems with WIT. However, for tumors >3 cm, none of the RNSs was found to have a statistically significant correlation with WIT, except for the tumor size (coefficient: 0.354, P = .027). For subcategories, axial scoring was found to have a consistent statistically significant correlation with WIT.
Overall, each RNS and tumor size strongly correlated with WIT in patients undergoing robotic partial nephrectomy. However, the RNS outperformed tumor size in small (<3 cm) renal masses with an optimal discriminating power, whereas for relatively larger (>3 cm) tumors, WIT was significantly dependent on tumor size, and every centimeter may count.
评估肿瘤大小、肾脏分段系统（RNSs），包括 RENAL、中心性指数（C-index）、术前解剖学方面和维度以及直径-轴向-极评分，以及这些 RNSs 的个体类别与热缺血时间（WIT）之间的关系。
从 2012 年到 2013 年，我们从一位外科医生的机器人部分肾切除术患者系列中确定了可获得 RNS 的患者。Spearman 相关性用于评估 RNS 与个体类别和 WIT 之间的关联。
对 69 例肿瘤大小中位数为 3.5cm（四分位间距 2.6-4.2）的患者进行了分析。总体而言，每个评分系统和肿瘤大小都与 WIT 具有统计学显著相关性，C-index 系统相关性最强（系数：-0.609，P<.001），这在外科医生学习曲线之外的系列中得到了证实。在相对较小的肾肿瘤（<3cm）亚组中，C-index、术前解剖学方面和维度以及直径-轴向-极系统与 WIT 之间存在统计学显著相关性。然而，对于肿瘤>3cm，除了肿瘤大小（系数：0.354，P=0.027）外，没有任何 RNS 与 WIT 具有统计学显著相关性。对于亚类，轴向评分与 WIT 具有一致的统计学显著相关性。
总体而言，每个 RNS 和肿瘤大小在接受机器人部分肾切除术的患者中与 WIT 强烈相关。然而，在小（<3cm）肾肿瘤中，RNS 优于肿瘤大小，具有最佳的区分能力，而对于相对较大（>3cm）的肿瘤，WIT 显著依赖于肿瘤大小，每厘米都可能有影响。
