Desantis Darren, Lavallée Luke T, Witiuk Kelsey, Mallick Ranjeeta, Kamal Fadi, Fergusson Dean, Morash Christopher, Cagiannos Ilias, Breau Rodney H
Department of Surgery, Division of Urology, Ottawa, ON;
Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON.
Can Urol Assoc J. 2015 Jan-Feb;9(1-2):39-45. doi: 10.5489/cuaj.2303.
We evaluate the associations between 3 renal tumour scoring systems and their components with perioperative complications of partial nephrectomy.
A consecutive cohort of partial nephrectomy patients was analyzed. Patient characteristics were abstracted from medical records. PADUA scores (preoperative aspects and dimensions used for anatomic classification), RENAL (radius exophyic/endophytic nearness anterior/posterior location scoring) nephrometry scores, and Centrality index (C-index) were determined from preoperative axial images by 2 independent reviewers. Cases were evaluated for postoperative complications up to 30 days after surgery. Pre-specified complication definitions were used for 33 potential medical and surgical complications. Unadjusted and adjusted associations between overall scores, individual components, and complications were determined using log binomial regression.
In total, 118 patients were included in the study. Of these, 36 (30.5%) surgical complications occurred in 27 (22.9%) patients. Fourteen (11.9%) were Clavien grade ≥3. Overall PADUA score was significantly associated with surgical and overall complications after adjusting for potential confounders. Among all components of the 3 scoring systems, only tumour diameter and exophytic/endophytic nature of the tumour were significantly associated with complications after adjusting for the other components of the respective scoring system (p < 0.05).
Renal tumour scoring systems may help predict the risk of complications after partial nephrectomy. Further refinement of current systems is required. A first step would be to include only components that are significantly associated with complications.
我们评估了3种肾肿瘤评分系统及其组成部分与部分肾切除术围手术期并发症之间的关联。
对连续的部分肾切除术患者队列进行分析。从病历中提取患者特征。由2名独立的审阅者根据术前轴向图像确定PADUA评分（用于解剖分类的术前方面和维度）、RENAL（外生性/内生性半径、前后位置评分）肾计量评分和中心性指数（C指数）。对病例进行术后30天内的并发症评估。使用预先指定的并发症定义评估33种潜在的医疗和手术并发症。使用对数二项回归确定总分、各个组成部分与并发症之间的未调整和调整后的关联。
该研究共纳入118例患者。其中，27例（22.9%）患者发生了36例（30.5%）手术并发症。14例（11.9%）为Clavien≥3级。在调整潜在混杂因素后，总体PADUA评分与手术和总体并发症显著相关。在这3种评分系统的所有组成部分中，在调整各自评分系统的其他组成部分后，只有肿瘤直径和肿瘤的外生性/内生性与并发症显著相关（p<0.05）。
肾肿瘤评分系统可能有助于预测部分肾切除术后的并发症风险。需要对当前系统进行进一步完善。第一步是只纳入与并发症显著相关的组成部分。
