Department of Urology, Lille University Hospital, Lille, France.
Service d'Urologie, Hôpital Claude Huriez, Rue Michel Polonowski, 59037, Lille, France.
World J Urol. 2023 Dec;41(12):3559-3566. doi: 10.1007/s00345-023-04633-3. Epub 2023 Oct 4.
Partial nephrectomy (PN) for large or complex renal tumors can be difficult and associated with a higher risk of recurrence than radical nephrectomy. We aim to evaluate the clinical useful of nephrometry scores for predicting oncological outcomes in a large cohort of patients who underwent PN for renal cell carcinomas.
Our analysis included patients who underwent PN for renal cell carcinoma in 21 French academic centers (2010-2020). RENAL, PADUA, and SPARE scores were calculated based on preoperative imaging. Uni- and multivariate cox models were performed to identify predictors of recurrence-free survival and overall survival. The area under the curve (AUC) was used to identify models with the highest discrimination. Decision curve analyses (DCAs) determined the net benefit associated with their use.
A total of 1927 patients were analyzed with a median follow-up of 32 months (14-45). RENAL score (p = 0.01), age (p = 0.002), histological type (p = 0.001), high nuclear grade (p = 0.001), necrotic component (p < 0.001), and positive margins (p = 0.005) were significantly related to recurrence in multivariate analyses. The discriminative performance of the 3 radiological scores was modest (65, 63, and 63%, respectively). All 3 scores showed good calibration, which, however, deteriorated with time. Decision curve analysis of the three models for the prediction of overall and recurrence-free survival was similar for all three scores and of limited clinical relevance.
The association between nephrometry scores and oncological outcomes after NP is very weak. The use of these scores for predicting oncological outcomes in routine practice is therefore of limited clinical value.
对于大型或复杂的肾肿瘤，部分肾切除术 (PN) 可能较为困难，且与根治性肾切除术相比，复发风险更高。我们旨在评估肾肿瘤患者行 PN 后，基于影像学的肾肿瘤影像学评分对肿瘤学结局的预测作用。
本研究纳入了 21 家法国学术中心 2010 年至 2020 年间行 PN 治疗的肾细胞癌患者。基于术前影像学计算 RENAL、PADUA 和 SPARE 评分。采用单变量和多变量 Cox 模型来确定无复发生存和总生存的预测因素。曲线下面积 (AUC) 用于识别具有最高区分度的模型。决策曲线分析 (DCA) 确定了使用这些模型的净获益。
共分析了 1927 例患者，中位随访时间为 32 个月（14-45 个月）。多变量分析显示，RENAL 评分（p=0.01）、年龄（p=0.002）、组织学类型（p=0.001）、核高级别（p=0.001）、坏死成分（p<0.001）和阳性切缘（p=0.005）与肿瘤复发显著相关。这 3 种影像学评分的判别性能中等（分别为 65%、63%和 63%）。所有 3 种评分均具有良好的校准度，但随着时间的推移校准度会降低。对于总生存和无复发生存的预测，3 种模型的 DCA 分析结果相似，对临床的参考价值有限。
PN 后肾肿瘤影像学评分与肿瘤学结局的相关性非常弱。因此，在常规实践中使用这些评分预测肿瘤学结局的临床价值有限。
