Department of Urology, Peking University First Hospital, National Urological Cancer Center, Institute of Urology, Peking University, No. 8 Xishiku Street, Xicheng District, Beijing, 100034, China.
Department of Urology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China.
World J Urol. 2023 Jul;41(7):1847-1853. doi: 10.1007/s00345-023-04448-2. Epub 2023 Jun 18.
To develop a 3D scoring system of tumor anatomy and intrarenal relationship for assessing surgical complexity and outcomes of robot-assisted partial nephrectomy (RAPN).
We prospectively enrolled patients with a renal tumor who had a 3D model and underwent RAPN between Mar 2019 and Mar 2022. The ADDD nephrometry consisted of the contact surface area between tumor and parenchyma (A), the depth of tumor invasion into the renal parenchyma (D), the distance from tumor to the main intrarenal artery (D), and to the collecting system (D). The primary outcomes included perioperative complication rate and trifecta outcome (WIT ≤ 25 min, negative surgical margins, and no major complications).
We enrolled a total of 301 patients. The mean tumor size was 2.93 ± 1.44 cm. There were 104 (34.6%) patients, 119 (39.5%) patients, and 78 (25.9%) patients in the low-, intermediate-, and high-risk groups, respectively. Each point increase in the ADDD score increased the risk of complications [hazard ratio (HR) 1.501]. A lower grade indicated a lower risk of failed trifecta (HR low group 15.103, intermediate group 9.258) and renal function damage (HR low risk 8.320, intermediate risk 3.165) compared to the high-risk group. The AUC of ADDD score and grade were 0.738 and 0.645 for predicting major complications, 0.766 and 0.714 for predicting trifecta outcome, and 0.746 and 0.730 for predicting postoperative renal function reservation.
The 3D-ADDD scoring system shows the tumor anatomy and its intraparenchymal relationships and has better efficacy in predicting surgical outcomes of RAPN.
建立三维肿瘤解剖和肾内关系评分系统，以评估机器人辅助部分肾切除术（RAPN）的手术复杂性和结果。
我们前瞻性地招募了 2019 年 3 月至 2022 年 3 月期间接受 RAPN 并具有 3D 模型的肾肿瘤患者。ADD 肾肿瘤体积评分由肿瘤与肾实质的接触表面积（A）、肿瘤侵犯肾实质的深度（D）、肿瘤与主要肾内动脉（D）和收集系统（D）的距离组成。主要结局包括围手术期并发症发生率和 trifecta 结局（WIT≤25min、阴性切缘和无重大并发症）。
共纳入 301 例患者。肿瘤平均大小为 2.93±1.44cm。低危、中危和高危组患者分别为 104（34.6%）例、119（39.5%）例和 78（25.9%）例。ADDD 评分每增加 1 分，并发症风险增加[风险比（HR）1.501]。低级别表明 trifecta 失败（低危组 HR 15.103，中危组 HR 9.258）和肾功能损害（低危组 HR 8.320，中危组 HR 3.165）的风险较低。ADDD 评分和分级预测主要并发症的 AUC 分别为 0.738 和 0.645，预测 trifecta 结局的 AUC 分别为 0.766 和 0.714，预测术后肾功能保留的 AUC 分别为 0.746 和 0.730。
3D-ADDD 评分系统显示了肿瘤解剖及其与肾内的关系，在预测 RAPN 手术结果方面具有更好的效果。
