Department of Urology, China Medical University Hospital, No. 2, Yu-De Rd., Taichung City, 404, Taiwan, Republic of China.
School of Medicine, China Medical University, No. 91, Xueshi Rd., North Dist, Taichung City, 404, Taiwan, Republic of China.
BMC Urol. 2019 Aug 5;19(1):72. doi: 10.1186/s12894-019-0504-2.
Functional outcome is an important issue in nephron-sparing surgery. Various nephrometries have been developed to predict renal function preservation. The aim of this study was to examine the applicability of R.E.N.A.L., PADUA, C-index, and mathematical tumor contact surface area (CSA) in predicting ipsilateral renal function after partial nephrectomy using radio-isotope scans.
We performed this retrospective study in patients who underwent partial nephrectomy between May 2013 and April 2017, and used abdominopelvic computerized tomography or magnetic resonance imaging to obtain R.E.N.A.L., C-index, and CSA. Renal function was measured by 99mTc mercaptoacetyltriglycine (MAG3). We evaluated correlations between nephrometries and perioperative parameters, and comparatively analyzed different nephrometries to determine the predictive ability in the percent change of effective renal plasma flow of the affected kidney.
Three, two, and 35 patients received partial nephrectomy in open, laparoscopic, and robotic approaches, respectively. The median (IQR) tumor size was 3.13 (2.4) cm. The median (IQR) R.E.N.A.L., PADUA, C-index, and CSA scores were 7 (3), 8 (2), 2.01 (1.87), and 14.14 (19.25) cm, respectively. Spearman correlation analysis showed that four nephrometries were correlated with each other. The strongest correlations were between CSA and C-index (coefficient: - 0.885, p < 0.001), followed by R.E.N.A.L. and PADUA (coefficient: 0.778, p < 0.001). Ischemia time was significantly correlated with R.EN.A.L. (coefficient: 0.35, p = 0.025), PADUA (coefficient: 0.42, p = 0.007), C-index (coefficient: - 0.45, p = 0.004), and CSA (coefficient: 0.41, p = 0.009). In multivariate analysis, PADUA significantly affected ischemia time (p = 0.04). The percent change in effective renal plasma flow (PCE) of the operated kidney was correlated with PADUA (coefficient: 0.48 p = 0.002), C-index (coefficient: - 0.74, p < 0.001), and CSA (coefficient: 0.75, p < 0.001). Only CSA and C-index independently affected PCE (both p < 0.05) in multivariate analysis. In ROC curve analysis, both C-index and CSA could predict 20% change in effective renal plasma flow (AUC: 0.91 vs 0.86, p = 0.2) of the affected kidney.
We suggest using PADUA to evaluate surgical complexity and ischemia time. Regarding the accuracy of the prediction of post-operative ipsilateral renal function, both CSA and C-index outperformed R.E.N.A.L. and PADUA nephrometries.
功能结果是保肾手术中的一个重要问题。已经开发了各种肾测量方法来预测肾功能的保留。本研究的目的是使用放射性同位素扫描检查 R.E.N.A.L.、PADUA、C 指数和数学肿瘤接触表面积（CSA）在预测部分肾切除术后同侧肾功能方面的适用性。
我们对 2013 年 5 月至 2017 年 4 月期间接受部分肾切除术的患者进行了回顾性研究，并使用腹盆计算机断层扫描或磁共振成像获取 R.E.N.A.L.、C 指数和 CSA。通过 99mTc 巯基乙酰三甘氨酸（MAG3）测量肾功能。我们评估了肾测量值与围手术期参数之间的相关性，并比较分析了不同的肾测量值，以确定其在受影响的肾脏有效肾血浆流量变化的百分比方面的预测能力。
分别有 3 例、2 例和 35 例患者接受了开放、腹腔镜和机器人手术。肿瘤大小的中位数（IQR）为 3.13（2.4）cm。R.E.N.A.L.、PADUA、C 指数和 CSA 评分的中位数（IQR）分别为 7（3）、8（2）、2.01（1.87）和 14.14（19.25）cm。Spearman 相关分析表明，四种肾测量值彼此相关。CSA 和 C 指数之间的相关性最强（系数：-0.885，p<0.001），其次是 R.E.N.A.L.和 PADUA（系数：0.778，p<0.001）。缺血时间与 R.E.N.A.L.（系数：0.35，p=0.025）、PADUA（系数：0.42，p=0.007）、C 指数（系数：-0.45，p=0.004）和 CSA（系数：0.41，p=0.009）显著相关。在多变量分析中，PADUA 显著影响缺血时间（p=0.04）。手术肾脏的有效肾血浆流量变化百分比（PCE）与 PADUA（系数：0.48，p=0.002）、C 指数（系数：-0.74，p<0.001）和 CSA（系数：0.75，p<0.001）相关。只有 CSA 和 C 指数在多变量分析中独立影响 PCE（均 p<0.05）。在 ROC 曲线分析中，C 指数和 CSA 均能预测受影响肾脏的有效肾血浆流量（AUC：0.91 与 0.86，p=0.2）的 20%变化。
我们建议使用 PADUA 来评估手术复杂性和缺血时间。就术后同侧肾功能的预测准确性而言，CSA 和 C 指数均优于 R.E.N.A.L.和 PADUA 肾测量。
