RENAL 评分在选定队列中对保肾手术结果预测的表现优于 PADUA 评分、C 指数和 DAP 评分。
R.E.N.A.L. Score Outperforms PADUA Score, C-Index and DAP Score for Outcome Prediction of Nephron Sparing Surgery in a Selected Cohort.
机构信息
Department of Urology, University Hospital Mainz, Mainz, Germany.
Department of Urology, University Hospital Frankfurt, Frankfurt, Germany.
出版信息
J Urol. 2016 Sep;196(3):664-71. doi: 10.1016/j.juro.2016.03.176. Epub 2016 Apr 14.
PURPOSE
Several nephrometry scores have been proposed to predict perioperative outcomes in renal surgery. We evaluated which nephrometry score correlates best with the MIC (margin, ischemia and complications) score and quantitative perioperative outcomes in nephron sparing surgery.
MATERIALS AND METHODS
Data on 188 patients undergoing nephron sparing surgery were retrospectively investigated for patient, operative and tumor characteristics. Nephrometry scores, including R.E.N.A.L. (radius, exophytic/endophytic properties, nearness of tumor to collecting system or sinus, anterior/posterior, hilar tumor touching the main renal artery or vein and location relative to polar lines), PADUA (preoperative aspects and dimensions used for an anatomical), C-index (concordance index) and DAP (diameter-axial-polar), were measured on preoperative computerized tomography or magnetic resonance imaging and coded continuously and categorically. Parameters pertaining to tumor margin, ischemia and complications were recorded as binary scores and classified as MIC achievement. Operative time, estimated blood loss, warm ischemia time and hospital stay were recorded as quantitative perioperative outcomes.
RESULTS
The R.E.N.A.L. score correlated best with MIC and quantitative perioperative outcomes. The continuously coded R.E.N.A.L. score was predictive of MIC on univariate analysis (OR 0.75, 95% CI 0.58-0.97, p = 0.03) and it had the best predictive value on multivariate logistic regression analysis (OR 0.31, 95% CI 0.18-0.82, p = 0.03). The C-index but not the PADUA or the DAP score was predictive of MIC on univariate and multivariate logistic regression analysis. MIC achievement rates were significantly higher for low than for high complexity tumors as assessed by categorically coded R.E.N.A.L. score, C-index and DAP scores. Continuously coded R.E.N.A.L. and PADUA scores positively correlated with operative time, warm ischemia time and hospital stay. The C-index and the DAP score correlated with warm ischemia time.
CONCLUSIONS
Of 4 nephrometry scores the R.E.N.A.L. score correlated best with MIC achievement and quantitative perioperative outcomes of nephron sparing surgery.
目的
已经提出了几种肾肿瘤体积测量评分来预测肾部分切除术的围手术期结果。我们评估了哪种肾肿瘤体积测量评分与 MIC（切缘、缺血和并发症）评分以及保肾手术的定量围手术期结果相关性最好。
材料与方法
回顾性调查了 188 例接受保肾手术的患者的患者、手术和肿瘤特征。在术前计算机断层扫描或磁共振成像上测量肾肿瘤体积测量评分，包括 R.E.N.A.L.（半径、外生性/内生性、肿瘤与收集系统或窦之间的距离、前后、 hilar 肿瘤接触主肾动脉或静脉以及相对于极线的位置）、PADUA（术前方面和用于解剖的维度）、C-index（一致性指数）和 DAP（直径-轴向-极向），并连续和分类编码。肿瘤切缘、缺血和并发症相关参数记录为二进制评分，并分类为 MIC 实现。记录手术时间、估计失血量、热缺血时间和住院时间作为定量围手术期结果。
结果
R.E.N.A.L.评分与 MIC 和定量围手术期结果相关性最好。连续编码的 R.E.N.A.L.评分在单因素分析中预测 MIC（OR 0.75，95%CI 0.58-0.97，p = 0.03），在多因素逻辑回归分析中具有最佳预测价值（OR 0.31，95%CI 0.18-0.82，p = 0.03）。C-index 但不是 PADUA 或 DAP 评分在单因素和多因素逻辑回归分析中预测 MIC。根据分类编码的 R.E.N.A.L.评分、C-index 和 DAP 评分，低复杂性肿瘤的 MIC 实现率显著高于高复杂性肿瘤。连续编码的 R.E.N.A.L.和 PADUA 评分与手术时间、热缺血时间和住院时间呈正相关。C-index 和 DAP 评分与热缺血时间相关。
结论
在 4 种肾肿瘤体积测量评分中，R.E.N.A.L.评分与 MIC 实现和保肾手术的定量围手术期结果相关性最好。
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