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Comparison of RENAL, PADUA, CSA, and PAVP Nephrometry Scores in Predicting Functional Outcomes After Partial Nephrectomy

      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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      References

        • Campbell S
        • Uzzo RG
        • Allaf ME
        • et al.
        Renal mass and localized renal cancer: AUA guideline.
        J Urol. 2017; 198: 520-529
        • Ljungberg B
        • Bensalah K
        • Canfield S
        • et al.
        EAU guidelines on renal cell carcinoma: 2014 update.
        Eur Urol. 2015; 67: 913-924
        • Zini L
        • Perrotte P
        • Capitanio U
        • et al.
        Radical versus partial nephrectomy: effect on overall and noncancer mortality.
        Cancer. 2009; 115: 1465-1471
        • Mir MC
        • Derweesh I
        • Porpiglia F
        • et al.
        Partial nephrectomy versus radical nephrectomy for clinical T1b and T2 renal tumors: a systematic review and meta-analysis of comparative studies.
        Eur Urol. 2017; 71: 606-617
        • Tan HJ
        • Norton EC
        • Ye Z
        • et al.
        Long-term survival following partial vs radical nephrectomy among older patients with early-stage kidney cancer.
        JAMA. 2012; 307: 1629-1635
        • Kaushik D
        • Kim SP
        • Childs MA
        • et al.
        Overall survival and development of stage IV chronic kidney disease in patients undergoing partial and radical nephrectomy for benign renal tumors.
        Eur Urol. 2013; 64: 600-606
        • Weight CJ
        • Lieser G
        • Larson BT
        • et al.
        Partial nephrectomy is associated with improved overall survival compared to radical nephrectomy in patients with unanticipated benign renal tumours.
        Eur Urol. 2010; 58: 293-298
        • Kutikov A
        • Uzzo RG
        The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth.
        J Urol. 2009; 182: 844-853
        • Ficarra V
        • Novara G
        • Secco S
        • et al.
        Preoperative aspects and dimensions used for an anatomical (PADUA) classification of renal tumours in patients who are candidates for nephron-sparing surgery.
        Eur Urol. 2009; 56: 786-793
        • Leslie S
        • Gill IS
        • de Castro Abreu AL
        • et al.
        Renal tumor contact surface area: a novel parameter for predicting complexity and outcomes of partial nephrectomy.
        Eur Urol. 2014; 66: 884-893
        • Klatte T
        • Ficarra V
        • Gratzke C
        • et al.
        A literature review of renal surgical anatomy and surgical strategies for partial nephrectomy.
        Eur Urol. 2015; 68: 980-992
        • Okhunov Z
        • Rais-Bahrami S
        • George AK
        • et al.
        The comparison of three renal tumor scoring systems: C-Index, P.A.D.U.A., and R.E.N.A.L. nephrometry scores.
        J Endourol. 2011; 25: 1921-1924
        • Borgmann H
        • Reiss AK
        • Kurosch M
        • et al.
        R.E.N.A.L. score outperforms PADUA score, C-Index and DAP score for outcome prediction of nephron sparing surgery in a selected cohort.
        J Urol. 2016; 196: 664-671
        • Kutikov A
        • Smaldone MC
        • Egleston BL
        • et al.
        Anatomic features of enhancing renal masses predict malignant and high-grade pathology: a preoperative nomogram using the RENAL nephrometry score.
        Eur Urol. 2011; 60: 241-248
        • Haifler M
        • Ristau BT
        • Higgins AM
        • et al.
        External validation of contact surface area as a predictor of post-operative renal function in patients undergoing partial nephrectomy.
        J Urol. 2018; 199(3): 649-654
        • Song C
        • Bang JK
        • Park HK
        • et al.
        Factors influencing renal function reduction after partial nephrectomy.
        J Urol. 2009; 181 (discussion 53-44): 48-53
        • Lane BR
        • Russo P
        • Uzzo RG
        • et al.
        Comparison of cold and warm ischemia during partial nephrectomy in 660 solitary kidneys reveals predominant role of nonmodifiable factors in determining ultimate renal function.
        J Urol. 2011; 185: 421-427
        • Dagenais J
        • Maurice MJ
        • Mouracade P
        • et al.
        Excisional precision matters: understanding the influence of excisional volume loss on renal function after partial nephrectomy.
        Eur Urol. 2017; 72: 168-170
        • Volpe A
        • Blute ML
        • Ficarra V
        • et al.
        Renal ischemia and function after partial nephrectomy: a collaborative review of the literature.
        Eur Urol. 2015; 68: 61-74
        • Tobert CM
        • Takagi T
        • Liss MA
        • et al.
        Multicenter validation of surgeon assessment of renal preservation in comparison to measurement with 3D image analysis.
        Urology. 2015; 86: 534-538
        • Zhao J
        • Zhang Z
        • Dong W
        • et al.
        preoperative prediction and postoperative surgeon assessment of volume preservation associated with partial nephrectomy: comparison with measured volume preservation.
        Urology. 2016; 93: 124-129
        • Levey AS
        • Stevens LA
        • Schmid CH
        • et al.
        A new equation to estimate glomerular filtration rate.
        Ann Intern Med. 2009; 150: 604-612
        • Finelli A
        • Ismaila N
        • Bro B
        • et al.
        Management of small renal masses: American society of clinical oncology clinical practice guideline.
        J Clin Oncol. 2017; 35: 668-680
        • Simmons MN
        • Fergany AF
        • Campbell SC
        Effect of parenchymal volume preservation on kidney function after partial nephrectomy.
        J Urol. 2011; 186: 405-410
        • Thompson RH
        • Boorjian SA
        • Lohse CM
        • et al.
        Radical nephrectomy for pT1a renal masses may be associated with decreased overall survival compared with partial nephrectomy.
        J Urol. 2008; 179 (discussion 472-463): 468-471
        • Yossepowitch O
        • Eggener SE
        • Serio A
        • et al.
        Temporary renal ischemia during nephron sparing surgery is associated with short-term but not long-term impairment in renal function.
        J Urol. 2006; 176 (discussion 1343): 1339-1343
        • Ting-Po Lin Y-MK
        • Chen Marcelo
        • Sun Fang-Ju
        Wun-Rong Lin: functional outcome prediction after partial nephrectomy using R.E.N.A.L. nephrometry, PADUA classification, and centrality index score.
        Urol Sci. 2017; 28: 10-13