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Hakimi K, Campbell SC, Nguyen MV, Rathi N, Wang L, Meagher MF, Rini BI, Ornstein M, McKay RR, Derweesh IH. PADRES: a phase 2 clinical trial of neoadjuvant axitinib for complex partial nephrectomy. BJU Int 2024; 133:425-431. [PMID: 37916303 DOI: 10.1111/bju.16217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
OBJECTIVE To report the results of PADRES (Prior Axitinib as a Determinant of Outcome of Renal Surgery, NCT03438708), a study investigating neoadjuvant axitinib for tumours of high complexity with imperative indication for partial nephrectomy (PN). METHODS We conducted a single-arm phase II clinical trial of localized (cT1b-cT3M0) clear-cell renal cell carcinoma (RCC) patients with imperative indications for nephron preservation, where PN is a high-risk procedure due to complexity (RENAL score 10-12). Axitinib 5 mg was administered twice daily for 8 weeks with repeat imaging at completion, followed by surgery. The primary outcome was successful completion of planned PN following axitinib treatment. Secondary objectives included changes in tumour diameter, RENAL nephrometry score, renal function and Response Evaluation Criteria in Solid Tumours (RECIST) v1.1, and surgical complications. RESULTS Twenty-seven patients were enrolled (median age 69 years). Prior to therapy, twenty patients (74.0%) had ≥ clinical T3a staged tumours. Axitinib resulted in reductions in tumour diameter (7.5 vs 6.2 cm; P < 0.001) and RENAL score (11 vs 10; P < 0.001). Nine patients (33.3%) had partial response based on RECIST and nine (33.3%) were clinically downstaged. PN was performed in twenty patients (74.0%); twenty-five patients (96.2%) had negative margins. Six patients (22.2%) had Clavien III-IV complications. The median change in estimated glomerular filtration rate (preoperative to last follow-up) was 8.5 mL/min/1.73 m2 . CONCLUSION Neoadjuvant axitnib resulted in reductions in tumour size and complexity, enabling safe and feasible PN and functional preservation in patients with complex renal masses and imperative indication.
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Affiliation(s)
- Kevin Hakimi
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA, USA
| | | | - Mimi V Nguyen
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA, USA
| | - Nityam Rathi
- Glickman Urological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Luke Wang
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA, USA
| | - Margaret F Meagher
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA, USA
| | - Brian I Rini
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Moshe Ornstein
- Department of Hematology and Oncology, Cleveland Clinic, Cleveland, OH, USA
| | - Rana R McKay
- Department of Medicine, UC San Diego School of Medicine, La Jolla, CA, USA
| | - Ithaar H Derweesh
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA, USA
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Kazan O, Cakici MC, Kokurcan A, Ozenc G, Karakoyunlu N, Atis G, Imamoglu MA, Yildirim A. Factors influencing the decision-making in laparoscopic partial nephrectomy for small renal masses. Urologia 2023; 90:693-701. [PMID: 37470329 DOI: 10.1177/03915603231189025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
BACKGROUND AND OBJECTIVES We analyzed the factors affecting the decision on surgical approach such as hilum dissection, vessel clamping, and the warm ischemia time (WIT) in laparoscopic partial nephrectomy (LPN) for small renal masses (SRMs). METHODS Patients who underwent LPN for SRMs between 2011 and 2021 in two centers were retrospectively screened. Standardized R.E.N.A.L. nephrometry score (RNS) and each of the components were scored on a Likert scale and the effect on the surgical approach was examined by using them separately. RESULTS A total of 133 patients, 85 of whom were on-clamp and 48 were off-clamp, were included in the study. Greater tumor size, low BMI, higher RNS, upper pole tumor, low exophytic rate, and nearness to the collecting system were statistically significant for both on/off-clamp and hilar dissection decisions. In multivariate analysis, greater tumor size, upper pole tumor, lower rate of exophytic part (E2), nearness to the collecting system (N3) were independent risk factors for vessel clamping. Greater tumor size and lower exophytic tumor rate (E2) were independent risk factors for hilum dissection. We could not identify any factor affecting WIT. CONCLUSION Individual components of RNS may serve as a better tool for decision-making on vessel clamping and hilum dissection during LPN for SRMs.
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Affiliation(s)
- Ozgur Kazan
- Department of Urology, School of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
- Department of Urology, School of Medicine, Kutahya University of Health Sciences, Kutahya, Turkey
| | - Mehmet Caglar Cakici
- Department of Urology, School of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Alihan Kokurcan
- Department of Urology, Diskapi Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Gorkem Ozenc
- Department of Urology, Diskapi Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Nihat Karakoyunlu
- Department of Urology, Diskapi Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Gokhan Atis
- Department of Urology, School of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | | | - Asif Yildirim
- Department of Urology, School of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
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Abdallah N, Wood A, Benidir T, Heller N, Isensee F, Tejpaul R, Corrigan D, Suk-Ouichai C, Struyk G, Moore K, Venkatesh N, Ergun O, You A, Campbell R, Remer EM, Haywood S, Krishnamurthi V, Abouassaly R, Campbell S, Papanikolopoulos N, Weight CJ. AI-generated R.E.N.A.L.+ Score Surpasses Human-generated Score in Predicting Renal Oncologic Outcomes. Urology 2023; 180:160-167. [PMID: 37517681 PMCID: PMC10592249 DOI: 10.1016/j.urology.2023.07.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 07/03/2023] [Accepted: 07/17/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVE To determine whether we can surpass the traditional R.E.N.A.L. nephrometry score (H-score) prediction ability of pathologic outcomes by creating artificial intelligence (AI)-generated R.E.N.A.L.+ score (AI+ score) with continuous rather than ordinal components. We also assessed the AI+ score components' relative importance with respect to outcome odds. METHODS This is a retrospective study of 300 consecutive patients with preoperative computed tomography scans showing suspected renal cancer at a single institution from 2010 to 2018. H-score was tabulated by three trained medical personnel. Deep neural network approach automatically generated kidney segmentation masks of parenchyma and tumor. Geometric algorithms were used to automatically estimate score components as ordinal and continuous variables. Multivariate logistic regression of continuous R.E.N.A.L. components was used to generate AI+ score. Predictive utility was compared between AI+, AI, and H-scores for variables of interest, and AI+ score components' relative importance was assessed. RESULTS Median age was 60years (interquartile range 51-68), and 40% were female. Median tumor size was 4.2 cm (2.6-6.12), and 92% were malignant, including 27%, 37%, and 23% with high-stage, high-grade, and necrosis, respectively. AI+ score demonstrated superior predictive ability over AI and H-scores for predicting malignancy (area under the curve [AUC] 0.69 vs 0.67 vs 0.64, respectively), high stage (AUC 0.82 vs 0.65 vs 0.71, respectively), high grade (AUC 0.78 vs 0.65 vs 0.65, respectively), pathologic tumor necrosis (AUC 0.81 vs 0.72 vs 0.74, respectively), and partial nephrectomy approach (AUC 0.88 vs 0.74 vs 0.79, respectively). Of AI+ score components, the maximal tumor diameter ("R") was the most important outcomes predictor. CONCLUSION AI+ score was superior to AI-score and H-score in predicting oncologic outcomes. Time-efficient AI+ score can be used at the point of care, surpassing validated clinical scoring systems.
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Affiliation(s)
- Nour Abdallah
- Glickman Urological and Kidney Institute, Cleveland, OH.
| | - Andrew Wood
- Glickman Urological and Kidney Institute, Cleveland, OH
| | - Tarik Benidir
- Glickman Urological and Kidney Institute, Cleveland, OH
| | - Nicholas Heller
- Department of Computer Science and Engineering, University of Minnesota, Minneapolis, MN
| | - Fabian Isensee
- German Cancer Research Center (DKFZ) Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Resha Tejpaul
- Department of Computer Science and Engineering, University of Minnesota, Minneapolis, MN
| | - Dillon Corrigan
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland, OH
| | | | - Griffin Struyk
- Department of Computer Science and Engineering, University of Minnesota, Minneapolis, MN
| | - Keenan Moore
- Department of Computer Science and Engineering, University of Minnesota, Minneapolis, MN
| | - Nitin Venkatesh
- Department of Computer Science and Engineering, University of Minnesota, Minneapolis, MN
| | | | - Alex You
- Case Western Reserve University, Cleveland, OH
| | | | - Erick M Remer
- Glickman Urological and Kidney Institute, Cleveland, OH; Department of Diagnostic Radiology, Imaging Institute, Cleveland Clinic, Cleveland, OH
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Andrade WS, Tang FHF, Mariotti ACH, Mancini MW, Duarte IX, Singer EA, Weiss RE, Pasqualini R, Arap W, Arap MA. Preclinical optimization of a diode laser-based clamp-free partial nephrectomy in a large animal model. Sci Rep 2023; 13:9237. [PMID: 37286592 DOI: 10.1038/s41598-023-35891-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/25/2023] [Indexed: 06/09/2023] Open
Abstract
Kidney cancer is a common urologic malignancy with either laparoscopic (LPN) or robotic partial nephrectomy as therapeutic options of choice for localized tumors. However, renal resection and suturing are challenging steps of the procedure that can lead to complications such as prolonged warm ischemia, bleeding, and urinary fistulas. LPN with a diode laser is an efficient technique due to its cutting and/or coagulation attributes. Surprisingly, key laser features such as wavelength and power remain undefined. Using a large porcine model, we evaluated the laser range of wavelength and power in a clamp-free LPN and compared it to the established gold-standard LPN technique (i.e., cold-cutting and suturing). By analyzing surgery duration, bleeding, presence of urine leak, tissue damage related to the resected renal fragment and the remaining organ, hemoglobin levels, and renal function, we show that an optimized experimental diode laser clamp-free LPN (wavelength, 980 nm; power, 15 W) had shorter surgery time with less bleeding, and better postoperative renal function recovery when compared to the well-established technique. Together, our data indicate that partial nephrectomy with a diode laser clamp-free LPN technique is an improved alternative to the gold-standard technique. Therefore, translational clinical trials towards human patient applications are readily feasible.
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Affiliation(s)
| | - Fenny H F Tang
- Rutgers Cancer Institute of New Jersey, Newark, NJ, USA
- Division of Cancer Biology, Department of Radiation Oncology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | | | - Marilia W Mancini
- Research and Education Center for Phototherapy in Health Sciences (NUPEN), São Carlos, SP, Brazil
| | | | - Eric A Singer
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
- Section of Urologic Oncology, Division of Urology, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Robert E Weiss
- Rutgers Cancer Institute of New Jersey, Newark, NJ, USA
- Division of Urology, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Renata Pasqualini
- Rutgers Cancer Institute of New Jersey, Newark, NJ, USA
- Division of Cancer Biology, Department of Radiation Oncology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Wadih Arap
- Rutgers Cancer Institute of New Jersey, Newark, NJ, USA.
- Division of Hematology/Oncology, Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA.
| | - Marco A Arap
- Hospital Sírio-Libanês, São Paulo, SP, Brazil.
- Department of Urology, University of São Paulo School of Medicine, São Paulo, SP, Brazil.
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A pilot study investigating the feasibility of using a fully automatic software to assess the RENAL and PADUA score. Prog Urol 2022; 32:558-566. [PMID: 35589469 DOI: 10.1016/j.purol.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 02/26/2022] [Accepted: 04/05/2022] [Indexed: 11/20/2022]
Abstract
PURPOSE Image-based morphometric scoring systems such as the RENAL and PADUA scores are useful to evaluate the complexity of partial nephrectomy for renal cell carcinoma (RCC). The main aim of this study was to develop a new imaging software to enable an automatic detection and a 3D visualization of RCC from CT angiography (CTA) and to address the feasibility to use it to evaluate the features of the RENAL and the PADUA scores. METHODS A training dataset of 210 patients CTA-scans manually segmented was used to train a deep learning algorithm to develop the automatic detection and 3D-visualization of RCC. A trained operator blindly assessed the RENAL and PADUA scores on a testing dataset of 41 CTA from patients with RCC using a commercialized semi-automatic software (ground truth) and the new automatic software. Concordance between the two methods was evaluated. RESULTS The median PADUA score was 9 (7-11) and the renal score was 8 (5.5-9). The automatic software enabled to automatically detect the tumoral kidney and provided a 3D-visualization in all cases, with a computational time less than 20 seconds. Concordances for staging the anatomical features of the RENAL scores were respectively: 87.8% for radius, 85.4% for exophytic rate, 82.9% for location to the polar lines and 92.7% for the antero-posterior location. For the PADUA scores, concordances were 90.2% for tumor size, 85.4% for exophytic rate, 87.8% for polar location and 100% for renal rim. CONCLUSION By enabling an automatic 3D-visualization of tumoral kidney, this software could help to calculate morphometric scores, save time and improve reproducibility for clinicians. LEVEL OF EVIDENCE: 4
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Abou Heidar N, Hakam N, El-Asmar JM, Najdi J, Khauli MA, Degheili J, El-Hajj A, Nasr R, Wazzan W, Bulbul M, Mukherji D, Khauli R. The R.E.N.A.L score’s relevance in determining perioperative and oncological outcomes: a Middle-Eastern tertiary care center experience. Arab J Urol 2022; 20:115-120. [PMID: 35935911 PMCID: PMC9354629 DOI: 10.1080/2090598x.2022.2064041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objective The aim of this study is to evaluate the significance of the R.E.N.A.L nephrometry scoring system in predicting perioperative and oncological outcomes and determining the surgical approach of choice for kidney tumors. Patients and Methods: Our study retrospectively reviewed outcomes from the year 2002 to 2017. Mann-Whitney U test was used to compare continuous variables and chi-square test was used to compare categorical variables. Kaplan-Meier estimates and multivariable cox proportional hazard regression were performed to determine an association between the different R.E.N.A.L categories and disease recurrence or mortality. Results A total of 325 patients underwent kidney surgery The most common R.E.N.A.L score category in our cohort study was intermediate (41.2%), followed by low, (33.2%) and high (25.5%). Patients with a high R.E.N.A.L score had worse perioperative outcomes compared to those with a low R.E.N.A.L score. High R.E.N.A.L score patients were 3 times more likely to receive blood transfusions compared to those with a low R.E.N.A.L score (19.4% vs 6.3%, p = 0.018), and a statistically significant longer hospital length of stay was also observed between the two groups (median 4.5 vs 4 days, p = 0.0419). In addition, the only predictor of disease recurrence or mortality was a high R.E.N.A.L score (Hazard Ratio (HR) 3.65, 95% Confidence Interval (CI) 1.05–12.7, p = 0.041). Conclusion Our study sheds light on the use of R.E.N.A.L nephrometry score in predicting perioperative, postoperative, and oncological outcomes. Such findings may play a role in optimizing surgical approaches and pre-operative patient counseling.
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Affiliation(s)
- Nassib Abou Heidar
- Division of Urology and Renal Transplantation, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nizar Hakam
- The Breyer Lab, University of California San Francisco, San Francisco, California, United States
| | - Jose M El-Asmar
- Division of Urology and Renal Transplantation, American University of Beirut Medical Center, Beirut, Lebanon
| | - Jad Najdi
- Division of Urology and Renal Transplantation, American University of Beirut Medical Center, Beirut, Lebanon
| | | | - Jad Degheili
- Division of Urology and Renal Transplantation, American University of Beirut Medical Center, Beirut, Lebanon
| | - Albert El-Hajj
- Division of Urology and Renal Transplantation, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rami Nasr
- Division of Urology and Renal Transplantation, American University of Beirut Medical Center, Beirut, Lebanon
| | - Wassim Wazzan
- Division of Urology and Renal Transplantation, American University of Beirut Medical Center, Beirut, Lebanon
| | - Muhammad Bulbul
- Division of Urology and Renal Transplantation, American University of Beirut Medical Center, Beirut, Lebanon
| | - Deborah Mukherji
- Division of Urology and Renal Transplantation, American University of Beirut Medical Center, Beirut, Lebanon
| | - Raja Khauli
- Division of Urology and Renal Transplantation, American University of Beirut Medical Center, Beirut, Lebanon
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Tsili AC, Andriotis E, Gkeli MG, Krokidis M, Stasinopoulou M, Varkarakis IM, Moulopoulos LA. The role of imaging in the management of renal masses. Eur J Radiol 2021; 141:109777. [PMID: 34020173 DOI: 10.1016/j.ejrad.2021.109777] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/09/2021] [Accepted: 05/14/2021] [Indexed: 12/26/2022]
Abstract
The wide availability of cross-sectional imaging is responsible for the increased detection of small, usually asymptomatic renal masses. More than 50 % of renal cell carcinomas (RCCs) represent incidental findings on noninvasive imaging. Multimodality imaging, including conventional US, contrast-enhanced US (CEUS), CT and multiparametric MRI (mpMRI) is pivotal in diagnosing and characterizing a renal mass, but also provides information regarding its prognosis, therapeutic management, and follow-up. In this review, imaging data for renal masses that urologists need for accurate treatment planning will be discussed. The role of US, CEUS, CT and mpMRI in the detection and characterization of renal masses, RCC staging and follow-up of surgically treated or untreated localized RCC will be presented. The role of percutaneous image-guided ablation in the management of RCC will be also reviewed.
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Affiliation(s)
- Athina C Tsili
- Department of Clinical Radiology, School of Health Sciences, Faculty of Medicine, University of Ioannina, 45110, Ioannina, Greece.
| | - Efthimios Andriotis
- Department of Newer Imaging Methods of Tomography, General Anti-Cancer Hospital Agios Savvas, 11522, Athens, Greece.
| | - Myrsini G Gkeli
- 1st Department of Radiology, General Anti-Cancer Hospital Agios Savvas, 11522, Athens, Greece.
| | - Miltiadis Krokidis
- 1st Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, 11528, Athens, Greece; Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital Bern University Hospital, University of Bern, 3010, Bern, Switzerland.
| | - Myrsini Stasinopoulou
- Department of Newer Imaging Methods of Tomography, General Anti-Cancer Hospital Agios Savvas, 11522, Athens, Greece.
| | - Ioannis M Varkarakis
- 2nd Department of Urology, National and Kapodistrian University of Athens, Sismanoglio Hospital, 15126, Athens, Greece.
| | - Lia-Angela Moulopoulos
- 1st Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, 11528, Athens, Greece.
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8
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Martini A, Fallara G, Pellegrino F, Cirulli GO, Larcher A, Necchi A, Montorsi F, Capitanio U. Neoadjuvant and adjuvant immunotherapy in renal cell carcinoma. World J Urol 2021; 39:1369-1376. [PMID: 33386494 DOI: 10.1007/s00345-020-03550-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 11/30/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE The treatment landscape for renal cell carcinoma (RCC) is rapidly evolving. The aim of this review is to summarize the randomized-controlled trials evaluating the role of immunotherapy in neoadjuvant or adjuvant setting. MATERIALS AND METHODS We searched PubMed, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov for studies including neoadjuvant or adjuvant immunotherapy, and provided a brief overview of the pharmacodynamics of immunotherapy for RCC. RESULTS Several drugs are currently under investigation. In the neoadjuvant setting, four studies are evaluating the role of single-agent immunotherapy, one of dual-agent immunotherapy, and four studies the role of immunotherapy in combination with tyrosine kinase inhibitors or anti-interleukin-1 beta. In the adjuvant setting, two studies are evaluating the role of single-agent immunotherapy and two of dual-agent immunotherapy. CONCLUSIONS The approval of immune checkpoint inhibition as a front-line therapeutic strategy for advanced RCC has also ultimately led to the investigation of these agents first in the adjuvant and then in the neoadjuvant setting. Currently, there are nine studies aimed to evaluate the role of immunotherapy in the neoadjuvant setting and four studies in the adjuvant setting.
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Affiliation(s)
- Alberto Martini
- Unit of Urology, University Vita-Salute, San Raffaele Scientific Institute, Milan, Italy
- Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Fallara
- Unit of Urology, University Vita-Salute, San Raffaele Scientific Institute, Milan, Italy
- Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Pellegrino
- Unit of Urology, University Vita-Salute, San Raffaele Scientific Institute, Milan, Italy
- Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Ottone Cirulli
- Unit of Urology, University Vita-Salute, San Raffaele Scientific Institute, Milan, Italy
- Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Larcher
- Unit of Urology, University Vita-Salute, San Raffaele Scientific Institute, Milan, Italy
- Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Necchi
- Unit of Urology, University Vita-Salute, San Raffaele Scientific Institute, Milan, Italy
- Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Montorsi
- Unit of Urology, University Vita-Salute, San Raffaele Scientific Institute, Milan, Italy
- Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Umberto Capitanio
- Unit of Urology, University Vita-Salute, San Raffaele Scientific Institute, Milan, Italy.
- Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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Shi N, Zu F, Shan Y, Chen S, Xu B, Du M, Chen M. The value of renal score in both determining surgical strategies and predicting complications for renal cell carcinoma: A systematic review and meta-analysis. Cancer Med 2020; 9:3944-3953. [PMID: 32281277 PMCID: PMC7286475 DOI: 10.1002/cam4.2993] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 02/29/2020] [Accepted: 02/29/2020] [Indexed: 01/20/2023] Open
Abstract
Objectives Radical nephrectomy (RN) was the standard treatment for renal cell carcinoma (RCC). However, recent studies have found that partial nephrectomy (PN) could achieve similar effects as radical nephrectomy, and has the advantages of less bleeding and shorter hospital stay. The choice of surgical strategies has become a concern of clinicians, which could be guided by renal score introduced by Kutikov et al Therefore, we conducted this meta‐analysis to clarify the value of renal score of determining surgical strategies and predicting complications. Methods The keywords “RENAL score,” “renal nephrometry score,” or “nephrometry score” were used to retrieve electronic databases for relevant literature up to Feb 2020, including PubMed, Web of Science, and the Cochrane library. Surgical strategies and complications are outcome measures. Risk ratio (RR) with 95% confidence intervals (CI) is applied to assess the effect size. Results A total of 20 studies met the selection criteria for meta‐analysis. There was significant difference in RN operation rate for each subgroup (low‐moderate: RR = 3.50, 95% Cl = 2.60‐4.71, P < .001; low‐high: RR = 6.29, 95% Cl = 4.40‐9.00, P < .001; moderate‐high: RR = 1.80, 95% Cl = 1.39‐2.32, P < .001).The overall incidence of complications from high renal score group was significantly higher than that in low renal score group (low‐moderate: RR = 1.32, 95% Cl = 1.03‐1.69, P = .026; low‐high: RR = 2.45, 95% Cl = 1.48‐4.07, P = .001; moderate‐high: RR = 1.75, 95% Cl = 1.17‐2.61, P = .007). Conclusions This meta‐analysis indicated that renal score is an efficient tool for determining surgical strategies and predicting complications in PN. More prospective research is essential to verify the predictive value of renal score.
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Affiliation(s)
- Naipeng Shi
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
| | - Feng Zu
- Department of Urology, Funing People's Hospital, Yancheng, Jiangsu, China
| | - Yong Shan
- Department of Urology, The Second People's Hospital of Taizhou, Taizhou, Jiangsu, China
| | - Shuqiu Chen
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
| | - Bin Xu
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
| | - Mulong Du
- Department of Environmental Genomics, Jiangsu Key Laboratory of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, China
| | - Ming Chen
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
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