Konstantinidis Cristian, Trilla Enrique, Serres Xavier, Montealegre Carolina, Lorente David, Castellón Rafael, Morote Juan
Department of Urology, Valld'Hebron University Hospital, Barcelona, Spain.
Universitat Autònoma de Barcelona, Spain.
Cent European J Urol. 2019;72(2):92-99. doi: 10.5173/ceju.2019.1833. Epub 2019 Jun 4.
An association between the R.E.N.A.L. nephrometry score (RNS) and clinical outcomes in patients with a small renal mass (SRM) has been proposed. We analyzed clinical outcomes according to the RNS in patients with a SRM treated with percutaneous contrast enhanced ultrasound (CEUS) radiofrequency ablation (RFA).
Patients with a SRM, who underwent RFA between January 2005 and March 2015, were retrospectively identified. The association between RNS and clinical outcomes was evaluated using parametric and non-parametric analysis.
We analyzed 163 SRMs in 149 consecutive patients. The mean age was 71.7 years. Mean follow-up time was 33.3 months ±20.6 (2-102). The mean RNS was 5.6 ±1.52 (4-11). A total of 121 (74.2%) cases were of low complexity and 42 (25.8%) were medium complexity. We identified 11 cases of tumor persistence (6.7%). The mean RNS was 5.58 in the cases with no persistence and 5.73 in the cases with persistence (p = 0.788). We identified 15 (9.2%) cases of recurrence. The mean RNS was 5.57 ±0.1 (4-11) in the cases without recurrence and 5.73 ±0.4 (4-9) in recurrence cases (p = 0.804). Of the 76 biopsy proven RCC cases, 8 (10.5%) cases of recurrence were observed, 5 in the low complexity group and 3 in the medium complexity group (p = 0.690). A total of 9 (5.5%) cases of complications were observed, with 5 (4.3%) in the low complexity group and 4 cases in the medium complexity group (p = 0.23). The mean length of stay was 1.5 days with a significant difference between low and medium complexity groups (1.3 vs. 2.1 days, p = 0.02). The mean difference between preoperative eGFR and estimated eGFRat 12 months was -3.08 mL / min ±13.3 (-49.4-34.1) and was significant (p = 0.008).However, this variation did not show significant differences between the low and medium complexity groups (p = 0.936). All-cause mortality was 11.7%, 14 cases (11.6%) in the low complexity group and 5 (11.9%) in the medium complexity group (p = 1.0). No cases of renal cell carcinoma (RCC) specific mortality were identified.
The RNS was not associated with tumor persistence, recurrence, cancer specific mortality, complications or renal function 12 months after the first treatment, showing significant difference only in length of hospital stay between low and medium complexity groups.
肾计量评分（RNS）与小肾肿块（SRM）患者的临床结局之间的关联已被提出。我们分析了接受经皮对比增强超声（CEUS）引导下射频消融（RFA）治疗的SRM患者根据RNS得出的临床结局。
回顾性纳入2005年1月至2015年3月期间接受RFA治疗的SRM患者。使用参数和非参数分析评估RNS与临床结局之间的关联。
我们分析了149例连续患者中的163个SRM。平均年龄为71.7岁。平均随访时间为33.3个月±20.6（2 - 102）。平均RNS为5.6±1.52（4 - 11）。共有121例（74.2%）为低复杂性，42例（25.8%）为中等复杂性。我们发现11例肿瘤持续存在（6.7%）。无肿瘤持续存在病例的平均RNS为5.58，有肿瘤持续存在病例的平均RNS为5.73（p = 0.788）。我们发现15例（9.2%）复发。无复发病例的平均RNS为5.57±0.1（4 - 11），复发病例的平均RNS为5.73±0.4（4 - 9）（p = 0.804）。在经活检证实的76例肾细胞癌（RCC）病例中，观察到8例（10.5%）复发，低复杂性组5例，中等复杂性组3例（p = 0.690）。共观察到9例（5.5%）并发症，低复杂性组5例（4.3%），中等复杂性组4例（p = 0.23）。平均住院时间为1.5天，低复杂性组和中等复杂性组之间存在显著差异（1.3天对2.1天，p = 0.02）。术前估算肾小球滤过率（eGFR）与术后12个月估算eGFR的平均差值为 - 3.08 mL/min±13.3（ - 49.4 - 34.1），差异有统计学意义（p = 0.008）。然而，这种变化在低复杂性组和中等复杂性组之间未显示出显著差异（p = 0.936）。全因死亡率为11.7%，低复杂性组14例（11.6%），中等复杂性组5例（11.9%）（p = 1.0）。未发现肾细胞癌（RCC）特异性死亡病例。
RNS与首次治疗后12个月的肿瘤持续存在、复发、癌症特异性死亡率、并发症或肾功能无关，仅低复杂性组和中等复杂性组之间的住院时间存在显著差异。
