Huang Mingchuan, Fei Yingchun, Zhong Zhihai, Jiang Hong, Liu Longshan, Liu Juncheng, Zhang Huanxi, Li Jun, Xu Zhe, Gao Pengfei, Wang Changxi
Department of Pediatric Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Front Pediatr. 2025 Jan 7;12:1501560. doi: 10.3389/fped.2024.1501560. eCollection 2024.
Comprehension of the anatomical characteristics of pediatric kidney tumors is crucial for making surgical decisions. Previous kidney tumor nephrometry systems failed to incorporate two significant factors: tumor thrombus and multifocality. We develop a refined nephrometry system based on a comprehensive understanding of the characteristics exhibited by pediatric kidney tumors.
The TUMORS nephrometry scoring system comprises 6 indicators, including tumor (T)hrombus, (U)rinary collecting system involvement, (M)ultiple tumors, (O)utward property, (R)adius, and (S)ite relative to the polar lines. Each renal unit was assessed and scored independently. The complexity characteristics of kidney tumors were summarized, and the correlation was compared with RENAL nephrometry system. Furthermore, the complexity of kidney tumors was compared across different surgical procedures.
A total of 43 patients were enrolled, involving 70 kidney units. Radical nephrectomy (RN) was performed on 13 kidneys, while the remaining 57 kidneys underwent nephron sparing surgery. In the NSS group, tumors in 37 kidneys were resected , whereas 20 kidneys underwent tumor resection followed by kidney autotransplantation. According to the TUMORS nephrometry scoring system, there were 13, 34 and 23 kidney units classified as low, moderate and high complexity, respectively. Tumors that underwent RN or removal exhibited higher complexity. The complications and positive margins of NSS were not statistically significant in relation to tumor complexity.
The TUMORS nephrometry scoring system holds significant guidance for the decision of surgical protocol and can be applied to the preoperative evaluation.
了解小儿肾肿瘤的解剖特征对于做出手术决策至关重要。以往的肾肿瘤肾计量系统未能纳入两个重要因素：肿瘤血栓和多灶性。我们基于对小儿肾肿瘤所表现特征的全面理解，开发了一种改进的肾计量系统。
TUMORS肾计量评分系统包括6个指标，即肿瘤（T）血栓、（U）肾盂受累情况、（M）多发肿瘤、（O）外生性、（R）半径以及相对于极线的（S）位置。对每个肾单位进行独立评估和评分。总结肾肿瘤的复杂性特征，并与RENAL肾计量系统比较相关性。此外，还比较了不同手术方式下肾肿瘤的复杂性。
共纳入43例患者，涉及70个肾单位。13个肾脏行根治性肾切除术（RN），其余57个肾脏行保肾手术。在保肾手术组中，37个肾脏的肿瘤被切除，而20个肾脏在肿瘤切除后行自体肾移植。根据TUMORS肾计量评分系统，分别有13、34和23个肾单位被归类为低、中、高复杂性。接受RN或切除的肿瘤表现出更高的复杂性。保肾手术的并发症和切缘阳性与肿瘤复杂性无统计学意义。
TUMORS肾计量评分系统对手术方案的决策具有重要指导意义，可应用于术前评估。
