Yallappa Sachin, Imran Rizwana, Rizvi Ishtiakul, Aboumarzouk Omar M, Bhatt Rupesh, Patel Prashant
Department of Urology, Queen Elizabeth Hospital, University Hospital of Birmingham, Birmingham, UK.
The Urology Research and Training Unit, Queen Elizabeth University Hospital, Glasgow, UK.
Urol Ann. 2018 Jul-Sep;10(3):270-279. doi: 10.4103/UA.UA_11_18.
Nephrometric scores are used to predict perioperative and postoperative complications, with no uniform results in the current literature.
A retrospective study of 141 patients in a single center who underwent open partial nephrectomy between June 2006 and 2016 for T1a and T1b renal tumor was conducted. Univariate and multivariate analyses were used to evaluate the correlations between preoperative aspects and dimensions used for an anatomical (PADUA) and radius exophytic/endophytic nearness anterior/posterior location (RENAL) scores and their components with pre-, peri-, and post-operative parameters. Linear regression (F-tests) and logical regression models were used to test for significance of the association and predictability of outcomes.
Total RENAL score ( = 0.032), its components R ( = 0.004), E ( = 0.022), L ( = 0.011), and total PADUA score ( = 0.016) were significantly associated with ischemic time. In postoperative complications, the PADUA components: sinus line location ( = 0.008), lateral/medial rim score ( = 0.029), and collecting system score ( = 0.006) showed significance. None of the variables showed correlation with operation time and change in estimated glomerular filtration rate (eGFR). On multivariate analysis, sinus line location and gender ( = 0.012) showed significance in predicting eGFR changes and RENAL score component: A ( = 0.049) was significant in predicting estimated blood loss. Both RENAL and PADUA components were significantly associated with hospital length of stay.
Both RENAL and PADUA scores showed important correlation in predicting outcomes. We further demonstrated the importance of knowing the individual components of the scores, which can independently give outcome predictions. The scoring systems can still be improved and standardized for broad clinical use with larger cohort and multicenter-based studies.
肾计量评分用于预测围手术期和术后并发症，目前文献中的结果并不统一。
对2006年6月至2016年期间在单一中心因T1a和T1b肾肿瘤接受开放性部分肾切除术的141例患者进行回顾性研究。采用单因素和多因素分析来评估用于解剖学（PADUA）评分和外生/内生半径前后位置（RENAL）评分及其组成部分的术前因素和维度与术前、术中及术后参数之间的相关性。使用线性回归（F检验）和逻辑回归模型来检验关联的显著性和结果的可预测性。
总RENAL评分（P = 0.032）、其组成部分R（P = 0.004）、E（P = 0.022）、L（P = 0.011）以及总PADUA评分（P = 0.016）与缺血时间显著相关。在术后并发症方面，PADUA组成部分：窦线位置（P = 0.008）、外侧/内侧边缘评分（P = 0.029）和集合系统评分（P = 0.006）具有显著性。没有变量与手术时间和估计肾小球滤过率（eGFR）变化相关。多因素分析显示，窦线位置和性别（P = 0.012）在预测eGFR变化方面具有显著性，RENAL评分组成部分：A（P = 0.049）在预测估计失血量方面具有显著性。RENAL和PADUA组成部分均与住院时间显著相关。
RENAL和PADUA评分在预测结果方面均显示出重要相关性。我们进一步证明了了解评分的各个组成部分的重要性，这些组成部分可以独立地给出结果预测。评分系统仍可通过更大队列和基于多中心的研究进行改进和标准化，以用于广泛的临床应用。
