Mouli Samdeep K, McDevitt Joseph L, Su Yu-Kai, Ragin Ann B, Gao Yi, Nemcek Albert A, Lewandowski Robert J, Salem Riad, Sato Kent T
Department of Radiology, Northwestern University Feinberg School of Medicine, 676 North St. Clair Street, Ste 800, Chicago, IL 60611.
Department of Radiology, Northwestern University Feinberg School of Medicine, 676 North St. Clair Street, Ste 800, Chicago, IL 60611.
J Vasc Interv Radiol. 2017 Jun;28(6):860-867. doi: 10.1016/j.jvir.2016.12.1224. Epub 2017 Mar 11.
To determine if modified RENAL (mRENAL) score and its individual components have superior predictive value relative to the RENAL nephrometry score in prediction of complications and recurrence after percutaneous renal cryoablation.
Primary masses treated with CT-guided percutaneous renal cryoablation between June 2007 and May 2016 were retrospectively reviewed. RENAL and mRENAL scores were used to stratify masses into low, medium, and high complexity tertiles. Complications were characterized by SIR criteria. Predictors of complications and local progression were analyzed using multivariate logistic regression and Kaplan-Meier analysis.
There were 95 renal cryoablation procedures in 86 patients. Of ablations, 89 had at least 1 follow-up imaging study, with median follow-up of 29 months. There were 11 (12.4%) complications, including 5 (6.5%) major complications. Mass complexity, as measured by mRENAL complexity tertile, was associated with increased risk of complications on multivariate analysis (P = .045). Endophytic location was the only individual ordinal component of the RENAL and mRENAL scores associated with complications (P = .021). Local progression occurred in 7 (8.3%) masses. Complexity as measured by either scoring system was not associated with local progression. Only diameter > 3 cm was associated with increased risk of local progression (hazard ratio = 9.9, 95% confidence interval = 2.1-45, P = .003).
mRENAL score was predictive of complications and tumor size was predictive of recurrence. Use of mRENAL score for complications and tumor size for recurrence should allow for simpler risk stratification and more accurate patient counseling.
确定改良RENAL（mRENAL）评分及其各个组成部分相对于RENAL肾计量评分在预测经皮肾冷冻消融术后并发症和复发方面是否具有更高的预测价值。
回顾性分析2007年6月至2016年5月间接受CT引导下经皮肾冷冻消融治疗的原发性肿块。使用RENAL和mRENAL评分将肿块分为低、中、高复杂性三分位数。并发症按照SIR标准进行分类。采用多因素逻辑回归和Kaplan-Meier分析来分析并发症和局部进展的预测因素。
86例患者共进行了95次肾冷冻消融手术。其中89次消融术后至少进行了1次随访影像学检查（中位数随访时间为29个月）。共有11例（12.4%）出现并发症，其中5例（6.5%）为严重并发症。经多因素分析，以mRENAL复杂性三分位数衡量的肿块复杂性与并发症风险增加相关（P = 0.045）。内生性位置是RENAL和mRENAL评分中与并发症相关的唯一单个有序组成部分（P = 0.021）。7例（8.3%）肿块出现局部进展。两种评分系统衡量的复杂性均与局部进展无关。仅直径> 3 cm与局部进展风险增加相关（风险比= 9.9，95%置信区间= 2.1 - 45，P = 0.003）。
mRENAL评分可预测并发症，肿瘤大小可预测复发。使用mRENAL评分评估并发症，肿瘤大小评估复发，应能实现更简单的风险分层和更准确的患者咨询。
