Abstract
Objective
To evaluate the accuracy of radius, exophytic/endophytic, nearness to collecting system/sinus,
anterior/posterior, and location relative to polar lines (RENAL), preoperative aspects
and dimensions used for anatomical classification (PADUA), contact surface area (CSA),
and preoperative assessment of volume preservation (PAVP) nephrometry scores in predicting
postoperative renal functional outcomes after partial nephrectomy (PN). Few studies
have compared the accuracy of tumor complexity systems directly in the same set of
PN patients.
Materials and Methods
Patients treated with robotic, laparoscopic, or open PN having available imaging (n = 344)
were examined. The ability of 4 systems to predict nadir estimated glomerular filtration
rate (eGFR [median postoperative day 1]) and new baseline eGFR (median: 0.95 year)
was analyzed using univariable and multivariable models.
Results
Median preoperative, nadir, and new baseline eGFR were 79 (interquartile range [IQR]:
63-97), 65 (IQR: 47-85), and 80 (IQR: 63-99) mL/min/1.73 m2. Multivariable models incorporating RENAL, PADUA, CSA, or PAVP were similarly predictive
of postoperative renal function (nadir eGFR: R2 = 0.683-0.688, new baseline eGFR: R2 = 0.775). In univariable analysis, all 4 complexity systems were predictors of nadir
GFR (each P < .05), with RENAL (P = .045), CSA (P = .027), and PAVP (P = .012) also significantly predicting nadir eGFR in multivariable models. No complexity
system was significantly associated with new baseline eGFR in multivariable analysis,
with only RENAL (P = .023) and PAVP (P = .049) having a statistically significant association in univariable analysis.
Conclusion
RENAL, PADUA, CSA, and PAVP are all predictors of early postoperative renal function.
RENAL and PAVP provided the greatest predictive ability for later renal functional
outcomes.
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Article info
Publication history
Published online: August 11, 2018
Accepted:
March 22,
2018
Received in revised form:
March 12,
2018
Received:
December 21,
2017
Footnotes
Conflicts of Interest: The authors have no conflicts of interest.
Funding Support: Funding was provided in part by the Spectrum Health Foundation, RG0813-1036.
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
