Anwaier Aihetaimujiang, Che Xiangxian, Shi Lei, Tian Xi, Ye Shiqi, Xu Wenhao, Zhu Yu, Zhang Hailiang, Ye Dingwei
Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China.
Shanghai Genitourinary Cancer Institute, Shanghai, China.
J Natl Cancer Cent. 2024 Jun 21;4(4):346-353. doi: 10.1016/j.jncc.2024.06.001. eCollection 2024 Dec.
Completely endophytic renal tumors (CERT) pose significant challenges due to their anatomical complexity and loss of visual clues about tumor location. A facile scoring model based on three-dimensional (3D) reconstructed images will assist in better assessing tumor location and vascular variations.
In this retrospective study, 80 patients diagnosed with CERT were included. Forty cases underwent preoperative assessment using 3D reconstructed imaging (3D-Cohort), while the remaining 40 cases were assessed using two-dimensional imaging (2D-Cohort). Vascular variations were evaluated by ascertaining the presence of renal arteries > 1, prehilar branching arteries, and arteries anterior to veins. The proposed scoring system, termed RAL, encompassed three critical components: (R)adius (maximal tumor diameter in cm), (A)rtery (occurrence of arterial variations), and (L)ocation relative to the polar line. Comparison of the RAL scoring system was made with established nephrometry scoring systems.
A total of 48 (60%) patients exhibited at least one vascular variation. In the 2D-Cohort, patients with vascular variations experienced significantly prolonged operation time, increased bleeding volume, and extended warm ischemia time compared with those without vascular variations. Conversely, the presence of vascular variations did not significantly affect operative parameters in the 3D-Cohort. Furthermore, the 2D-Cohort demonstrated a notable decline in both short- and long-term estimated glomerular filtration rate (eGFR) changes compared with the 3D-Cohort, a trend consistent across patients with warm ischemia time ≥ 25 min and those with vascular variations. Notably, the 2D-Cohort exhibited a larger margin of normal renal tissue compared with the 3D-Cohort. Elevated RAL scores correlated with larger tumor size, prolonged operation time, extended warm ischemia time, and substantial postoperative eGFR decrease. The RAL scoring system displayed superior predictive capabilities in assessing postoperative eGFR changes compared with conventional nephrometry scoring systems.
Our proposed 3D vascular variation-based nephrometry scoring system offers heightened proficiency in preoperative assessment, precise prediction of surgical complexity, and more accurate evaluation of postoperative renal function in CERT patients.
完全内生性肾肿瘤（CERT）因其解剖结构复杂且缺乏肿瘤位置的视觉线索而带来重大挑战。基于三维（3D）重建图像的简易评分模型将有助于更好地评估肿瘤位置和血管变异情况。
在这项回顾性研究中，纳入了80例诊断为CERT的患者。40例患者采用3D重建成像进行术前评估（3D队列），其余40例患者采用二维成像进行评估（2D队列）。通过确定是否存在大于1支肾动脉、肾门前分支动脉以及静脉前方的动脉来评估血管变异情况。所提出的评分系统称为RAL，包括三个关键要素：（R）半径（肿瘤最大直径，单位为厘米）、（A）动脉（动脉变异的发生情况）和（L）相对于极线的位置。将RAL评分系统与既定的肾计量评分系统进行比较。
共有48例（60%）患者表现出至少一种血管变异。在2D队列中，与无血管变异的患者相比，有血管变异的患者手术时间显著延长、出血量增加且热缺血时间延长。相反，血管变异的存在在3D队列中并未显著影响手术参数。此外，与3D队列相比，2D队列在短期和长期估计肾小球滤过率（eGFR）变化方面均有显著下降，这一趋势在热缺血时间≥25分钟的患者和有血管变异的患者中均一致。值得注意的是，与3D队列相比，2D队列正常肾组织边缘更大。RAL评分升高与肿瘤尺寸增大、手术时间延长、热缺血时间延长以及术后eGFR大幅下降相关。与传统肾计量评分系统相比，RAL评分系统在评估术后eGFR变化方面显示出卓越的预测能力。
我们提出的基于3D血管变异的肾计量评分系统在CERT患者的术前评估、手术复杂性的精确预测以及术后肾功能的更准确评估方面具有更高的熟练度。
