Harvard Medical School, Boston, Massachusetts.
Department of Radiology, University of Alabama School of Medicine, Birmingham, Alabama.
J Vasc Interv Radiol. 2022 Jun;33(6):695-701. doi: 10.1016/j.jvir.2022.03.011. Epub 2022 Mar 17.
To assess the utility of the radius, exophytic/endophytic, nearness to collecting system or sinus, anterior/posterior, and location relative to polar lines (RENAL) nephrometry scoring system at predicting adverse events and outcomes in percutaneous microwave ablation (MWA) of renal tumors.
A retrospective review of 116 patients who underwent MWA from 2004 to 2018 at 2 large university hospitals was conducted. Patient demographics and tumor characteristics were collected. The RENAL nephrometry scores were calculated, and procedure-related adverse events were stratified into minor and major (the Society of Interventional Radiology classification of class C or higher). Technical and oncologic outcomes were based on follow-up magnetic resonance imaging and computed tomography scans after ablation.
The mean RENAL score was 6.6 (range, 4-11), and the mean tumor size was 24 mm. Follow-up ranged between 16 and 161 weeks (median, 50 weeks; mean, 65 weeks). Oncologic control was achieved in 96% (n = 111) of patients. The major and minor adverse event rates were 8.6% (n = 10) and 17% (n = 19), respectively. The mean RENAL score for patients with recurrent and/or residual tumor (8.2 ± 2.7) was higher than that for patients without disease recurrence (6.5 ± 3.5, P = .05). However, in a multivariate analysis, the RENAL score was not found to be an independent predictor of oncologic outcomes (odds ratio, 1.548; P = .092).
The RENAL nephrometry score has minimal utility for predicting outcomes and adverse events in MWA of renal tumors. The inconsistent nature of RENAL nephrometry scoring in percutaneous ablation procedures underscores the need for an ablation-specific risk stratification system.
评估 RENAL 肾脏肿瘤外科学评分系统的半径、外生/内生、与收集系统或窦接近程度、前后位置和相对于极线的位置在预测经皮微波消融 (MWA) 治疗肾肿瘤的不良事件和结局方面的效用。
对 2004 年至 2018 年在 2 家大型大学医院接受 MWA 治疗的 116 例患者进行回顾性研究。收集患者的人口统计学和肿瘤特征数据。计算 RENAL 肾脏肿瘤外科学评分，并将与手术相关的不良事件分为轻微和严重（介入放射学会分类 C 级或更高）。技术和肿瘤学结果基于消融后随访的磁共振成像和计算机断层扫描。
平均 RENAL 评分为 6.6（范围，4-11），平均肿瘤大小为 24mm。随访时间为 16-161 周（中位数，50 周；平均，65 周）。96%（n=111）的患者获得了肿瘤无进展生存。严重和轻微不良事件发生率分别为 8.6%（n=10）和 17%（n=19）。有复发和/或残留肿瘤的患者的平均 RENAL 评分（8.2±2.7）高于无疾病复发的患者（6.5±3.5，P=0.05）。然而，在多变量分析中，RENAL 评分并不是肿瘤学结果的独立预测因素（优势比，1.548；P=0.092）。
RENAL 肾脏肿瘤外科学评分系统对于预测 MWA 治疗肾肿瘤的结局和不良事件的作用不大。经皮消融手术中 RENAL 肾脏肿瘤外科学评分的不一致性突显了需要建立一种针对消融的风险分层系统。
