Ficarra Vincenzo, Porpiglia Francesco, Crestani Alessandro, Minervini Andrea, Antonelli Alessandro, Longo Nicola, Novara Giacomo, Giannarini Gianluca, Fiori Cristian, Simeone Claudio, Carini Marco, Mirone Vincenzo
Department of Human and Pediatric Pathology 'Gaetano Barresi', Urologic Section, University of Messina, Messina, Italy.
Division of Urology, San Luigi Gonzaga Hospital Orbassano, University of Turin, Turin, Italy.
BJU Int. 2019 Oct;124(4):621-628. doi: 10.1111/bju.14772. Epub 2019 May 7.
To simplify the original Preoperative Aspects and Dimensions Used for an Anatomical (PADUA) classification of renal tumours, generating a new system able to predict equally or better the risk of overall complications in patients undergoing partial nephrectomy (PN); and to test if the addition of the contact surface area (CSA) parameter improves the accuracy of the original PADUA and new Simplified PADUA REnal (SPARE) nephrometry classification systems.
We analysed the clinical records of 531 patients who underwent PN (open, laparoscopic and robot-assisted) for renal tumours at five tertiary academic referral centres from January 2014 to December 2016. The ability of each variable included in the PADUA classification to predict overall complications was tested using binary logistic regression analysis. The variables that were not statistically significant were excluded from the SPARE classification. In addition to the original PADUA and SPARE systems, another two models were generated adding tumour CSA. Receiver operating characteristic curve analysis was used to compare the ability of the four different models to predict overall complications. Binary logistic regression was used to perform both univariable and multivariable analyses looking for predictors of postoperative complications. Linear regression analysis was used to identify independent predictors of absolute change in estimated glomerular filtration rate (eGFR; ACE).
The SPARE nephrometry score system including: (i) rim location, (ii) renal sinus involvement, (iii) exophytic rate, and (iv) tumour dimension; showed equal performance in comparison with the original PADUA score (area under the curve [AUC] 0.657 vs 0.664). Adding tumour CSA to the original PADUA (AUC 0.661) or to the SPARE (AUC 0.658) scores did not increase the accuracy of either system to predict overall complications. The SPARE system (odds ratio 1.2, 95% confidence interval 1.1-1.3) was an independent predictor of postoperative overall complications. Age (P < 0.001), body mass index (P < 0.001), Charlson Comorbidity Index (P = 0.02), preoperative eGFR (P < 0.001), and tumour CSA (P = 0.005) were independent predictors of ACE. Limitations include the retrospective design and the lack of central imaging review.
The new SPARE score is comprised of only four variables instead of the original six and its accuracy to predict overall complications is similar to that of the original PADUA score. Addition of tumour CSA was not associated with an increase in prognostic accuracy. The SPARE system could replace the original PADUA score to evaluate the complexity of tumours suitable for PN.
简化最初用于肾肿瘤解剖学（PADUA）分类的术前因素及维度，生成一个能够同等或更好地预测接受部分肾切除术（PN）患者总体并发症风险的新系统；并测试添加接触表面积（CSA）参数是否能提高原始PADUA和新的简化PADUA肾测量（SPARE）分类系统的准确性。
我们分析了2014年1月至2016年12月期间在五个三级学术转诊中心接受PN（开放手术、腹腔镜手术和机器人辅助手术）治疗肾肿瘤的531例患者的临床记录。使用二元逻辑回归分析测试PADUA分类中包含的每个变量预测总体并发症的能力。将无统计学意义的变量从SPARE分类中排除。除了原始的PADUA和SPARE系统外，还生成了另外两个添加肿瘤CSA的模型。使用受试者工作特征曲线分析比较四种不同模型预测总体并发症的能力。使用二元逻辑回归进行单变量和多变量分析以寻找术后并发症的预测因素。使用线性回归分析确定估计肾小球滤过率（eGFR；ACE）绝对变化的独立预测因素。
SPARE肾测量评分系统包括：（i）边缘位置，（ii）肾窦受累情况，（iii）外生性率，以及（iv）肿瘤大小；与原始PADUA评分相比表现相当（曲线下面积[AUC]分别为0.657和0.664）。在原始PADUA评分（AUC 0.661）或SPARE评分（AUC 0.658）中添加肿瘤CSA并未提高任何一个系统预测总体并发症的准确性。SPARE系统（比值比1.2，95%置信区间1.1 - 1.3）是术后总体并发症的独立预测因素。年龄（P < 0.001）、体重指数（P < 0.001）、Charlson合并症指数（P = 0.02）、术前eGFR（P < 0.001）和肿瘤CSA（P = 0.005）是ACE的独立预测因素。局限性包括回顾性设计以及缺乏中心影像学审查。
新的SPARE评分仅由四个变量组成而非原来的六个，其预测总体并发症的准确性与原始PADUA评分相似。添加肿瘤CSA与预后准确性的提高无关。SPARE系统可替代原始PADUA评分来评估适合PN的肿瘤的复杂性。
