Department of Plastic and Reconstructive Oncourology, National Cancer Institute of Ukraine, Kyiv, Ukraine; Department of Urology, Faculty of Medicine, University Hospital Cologne, University Cologne, Cologne, Germany.
Department of Plastic and Reconstructive Oncourology, National Cancer Institute of Ukraine, Kyiv, Ukraine.
Urol Oncol. 2024 Dec;42(12):454.e9-454.e19. doi: 10.1016/j.urolonc.2024.09.019. Epub 2024 Oct 2.
to determine the key factors affecting the surgical treatment selection for patients with localized Renal-Cell Carcinoma (RCC) based on clinical and nephrometry data.
A retrospective cohort study to determine the key factors affecting the surgical treatment on a subset of patients with localized RCC (T1-T2) that underwent surgical treatment at primary investigational center from 2010 to 2017. Primary results were validated on the retrospective dataset of patients treated at high-volume referent center. Validation aimed to test applicability of the predictive model designed during primary analysis. To determine the relationship between the risks of radical or partial nephrectomy, the multivariate predictive modeling method was used.
Based on the analysis, for polary and laterally located tumors, the risk of RN was conditioned only by remaining functioning parenchyma volume (RFPV). The average critical value of RFPV for polar lesions was = 58%; for lateral tumors = 67%. For medial location, the risk of RN only depended on the tumor size. Average critical value of the tumor size in the medial location was = 38mm. Based on the ROC curve comparison, there were no statistically significant differences between the predictive models containing 12 and 3 factors (AUC and AUC; P = 0.12); thus, the reduced amount of the factor indicators from 12 to 3 did not worsen the model predictive qualities. Designed during primary analysis hypothesis was successfully validated in a referent center on the cohort of 300 patients. Predictive model is characterized by high sensitivity (95.2%) and specificity (95.4%) in selecting patients for partial nephrectomy.
For the polar and lateral tumor locations, the functioning parenchymal volumes of over 58 and 67% respectively serve as PN indications. However, for the medial lesions, the primary PN indication is a tumor size less than 38 mm.
根据临床和肾肿瘤学数据，确定影响局限性肾细胞癌（RCC）患者手术治疗选择的关键因素。
回顾性队列研究，旨在确定 2010 年至 2017 年在主要研究中心接受手术治疗的局限性 RCC（T1-T2）患者子集的手术治疗的关键因素。主要结果在高容量参考中心治疗的患者的回顾性数据集上进行验证。验证旨在测试在主要分析中设计的预测模型的适用性。为了确定根治性或部分肾切除术的风险之间的关系，使用多变量预测建模方法。
基于分析，对于极性和侧向肿瘤，RN 的风险仅受剩余功能肾实质体积（RFPV）的影响。极性病变 RFPV 的平均临界值为 = 58%；对于侧向肿瘤，临界值为 = 67%。对于内侧位置，RN 的风险仅取决于肿瘤的大小。内侧位置肿瘤大小的平均临界值为 = 38mm。基于 ROC 曲线比较，包含 12 个和 3 个因素的预测模型之间没有统计学差异（AUC 和 AUC；P = 0.12）；因此，从 12 个减少到 3 个因素指标并没有降低模型预测质量。在参考中心对 300 例患者队列进行的初步分析中成功验证了假设。预测模型在选择部分肾切除术患者方面具有高灵敏度（95.2%）和特异性（95.4%）。
对于极性和侧向肿瘤位置，分别超过 58%和 67%的功能肾实质体积可作为 PN 指征。然而，对于内侧病变，主要的 PN 指征是肿瘤大小小于 38mm。
