Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Temple University School of Medicine, Philadelphia, PA.
Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Temple University School of Medicine, Philadelphia, PA.
Urology. 2014 Aug;84(2):351-7. doi: 10.1016/j.urology.2014.05.001. Epub 2014 Jun 26.
To internally validate the renal pelvic score (RPS) in an expanded cohort of patients undergoing partial nephrectomy (PN).
Our prospective institutional renal cell carcinoma database was used to identify all patients undergoing PN for localized renal cell carcinoma from 2007 to 2013. Patients were classified by RPS as having an intraparenchymal or extraparenchymal renal pelvis. Multivariate logistic regression models were used to examine the relationship between RPS and urine leak.
Eight hundred thirty-one patients (median age, 60 ± 11.6 years; 65.1% male) undergoing PN (57.3% robotic) for low (28.9%), intermediate (56.5%), and high complexity (14.5%) localized renal tumors (median size, 3.0 ± 2.3 cm; median nephrometry score, 7.0 ± 2.6) were included. Fifty-four patients (6.5%) developed a clinically significant or radiographically identified urine leak. Seventy-two of 831 renal pelvises (8.7%) were classified as intraparenchymal. Intrarenal pelvic anatomy was associated with a markedly increased risk of urine leak (43.1% vs 3.0%; P <.001), major urine leak requiring intervention (23.6% vs 1.7%; P <.001), and minor urine leak (19.4% vs 1.2%; P <.001) compared with that in patients with an extrarenal pelvis. After multivariate adjustment, RPS (intraparenchymal renal pelvis; odds ratio [OR], 24.8; confidence interval [CI], 11.5-53.4; P <.001) was the most predictive of urine leak as was tumor endophyticity ("E" score of 3 [OR, 4.5; CI, 1.3-15.5; P = .018]), and intraoperative collecting system entry (OR, 6.1; CI, 2.5-14.9; P <.001).
Renal pelvic anatomy as measured by the RPS best predicts urine leak after open and robotic partial nephrectomy. Although external validation of the RPS is required, preoperative identification of patients at increased risk for urine leak should be considered in perioperative management and counseling algorithms.
在接受部分肾切除术 (PN) 的扩展患者队列中对肾盂评分 (RPS) 进行内部验证。
我们使用前瞻性的机构肾细胞癌数据库来确定 2007 年至 2013 年间接受 PN 治疗局限性肾细胞癌的所有患者。根据 RPS 将患者分为肾盂位于肾实质内或肾实质外。使用多变量逻辑回归模型检查 RPS 与尿漏之间的关系。
831 例（中位年龄 60 ± 11.6 岁；65.1%为男性）接受 PN（57.3%为机器人）治疗低（28.9%）、中（56.5%）和高复杂性（14.5%）局限性肾肿瘤（中位大小 3.0 ± 2.3 cm；中位肾肿瘤评分 7.0 ± 2.6）。54 例（6.5%）患者出现临床显著或影像学诊断的尿漏。831 个肾盂中有 72 个（8.7%）被归类为肾实质内。肾内肾盂解剖结构与尿漏风险显著增加相关（43.1%比 3.0%；P<.001），需要干预的主要尿漏（23.6%比 1.7%；P<.001）和次要尿漏（19.4%比 1.2%；P<.001）。与肾盂位于肾外的患者相比。多变量调整后，RPS（肾实质内肾盂；优势比 [OR]，24.8；置信区间 [CI]，11.5-53.4；P<.001）是预测尿漏的最具预测性的指标，肿瘤内生性（“E”评分 3 [OR，4.5；CI，1.3-15.5；P=.018]）和术中收集系统进入（OR，6.1；CI，2.5-14.9；P<.001）。
RPS 测量的肾盂解剖结构是预测开放和机器人辅助部分肾切除术后尿漏的最佳指标。虽然需要对 RPS 进行外部验证，但应在围手术期管理和咨询算法中考虑术前识别尿漏风险增加的患者。
