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Hu C, Sun J, Zhang Z, Zhang H, Zhou Q, Xu J, Ling Z, Ouyang J. Parallel comparison of R.E.N.A.L., PADUA, and C-index scoring systems in predicting outcomes after partial nephrectomy: A systematic review and meta-analysis. Cancer Med 2021; 10:5062-5077. [PMID: 34258874 PMCID: PMC8335816 DOI: 10.1002/cam4.4047] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/05/2021] [Accepted: 05/14/2021] [Indexed: 12/18/2022] Open
Abstract
Objective To parallelly compare the applicability of the radius, exophytic/endophytic, nearness, anterior/posterior, location nephrometry score (R.E.N.A.L.), the Preoperative Aspects and Dimensions Used for an Anatomical (PADUA), and the centrality index (C‐index) scoring systems in predicting clinical outcomes after partial nephrectomy (PN). Methods We searched EMBASE, PubMed, Ovid, and Web of Science to perform a meta‐analysis examining the correlation coefficients between three nephrometry scores (NSs) and warm ischemia time (WIT), estimated blood loss (EBL), operation time (OT), length of stay (LOS), and absolute change in eGFR (ACE) up to 25 January 2021. Results In total, 13 studies including 1496 patients met the criteria for further analysis. Overall, all scoring systems had statistically significant correlations with the WIT, EBL, OT, ACE and LOS and ACE, except for the correlation between PADUA and LOS (r = 0.16 [−0.00, 0.31], p > 0.05). The C‐index had the strongest correlation with WIT (r = −0.35 [−0.43, −0.26], p < 0.05) and ACE (r = −0.29 [−0.48, −0.10], p < 0.05). Weak correlations were observed between OT as well as EBL and each scoring system. Publication bias was observed in PADUA score predicting ACE (p = 0.04) and high heterogeneity was found in some of our results. Conclusion Until now, this is the first meta‐analysis that parallelly compares these three scoring systems in predicting outcomes after PN. We found that all NSs showed a statistically significant correlation with WIT, EBL, OT, and ACE. Moreover, the C‐index scoring system is the best predictor of WIT and ACE. Due to the existence of publication bias and high heterogeneity, more well‐designed and large‐scale studies are warranted for validation. To our knowledge, this is the first meta‐analysis that parallelly compares these three scoring systems in predicting outcomes after PN. Overall, three scoring systems were significantly correlated with WIT, EBL, OT and ACE. Moreover, the C‐index scoring system outperformed R.E.N.A.L. and PADUA scoring systems in WIT and ACE.
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Affiliation(s)
- Can Hu
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jiale Sun
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhiyu Zhang
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Haoyang Zhang
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Qi Zhou
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jiangnan Xu
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhixin Ling
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jun Ouyang
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China
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Salah M, ElSheemy MS, Ghoneima W, Abd El Hamid M, Kassem A, Ashmawy AA, Saad IR, Mosharafa AA, Salem HK, Badawy H, Salem A. Modified R.E.N.A.L nephrometry score for predicting the outcome following partial nephrectomy. AFRICAN JOURNAL OF UROLOGY 2020. [DOI: 10.1186/s12301-020-00056-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Abstract
Background
It was difficult to compare the outcome of partial nephrectomy among different studies due to the absence of standardized description of different renal masses. This problem led to the development of nephrometry scoring systems. R.E.N.A.L. is among the commonest nephrometry scoring systems; however, some studies failed to find any relation between R.E.N.A.L. with perioperative outcome. We evaluated our designed newly modified nephrometry score in prediction of outcome following partial nephrectomy and compared its predictability versus original R.E.N.A.L.
Methods
Fifty-one patients with cT1-2N0M0 renal masses amenable for partial nephrectomy were included prospectively. Different perioperative outcome variables were compared according to complexity level in R.E.N.A.L. and the newly modified nephrometry score.
Results
Clinical staging was T1a (21.6%), T1b (49%), T2a (25.5%), T2b (3.9%). Median R.E.N.A.L. was 9 (4–12). Hilar position and intrarenal pelvis were detected in 19.6% and 68.6%. Low, moderate and high complexity masses were found in 21.6%, 39.2% and 39.2%. Complications and rate of conversion to radical nephrectomy were 17 (33.3%) and 4 (7.8%). The only significantly affected variable (p = 0.039) by R.E.N.A.L. was rate of secondary intervention, but it was higher in low than in high complexity level. In the newly modified nephrometry score, complications (p = 0.037) and rate of positive surgical margin (p = 0.049) were significantly higher with increased complexity level. Although other variables (pelvi-calyceal system entry, operative time, blood loss, hemoglobin loss, blood transfusion and conversion to radical nephrectomy) did not show statistically significant difference according to both scores, they were better associated with the complexity level in the newly modified nephrometry score with their remarkable increase in the high when compared to the low complexity level.
Conclusions
The newly modified nephrometry score was associated with better prediction of outcome of partial nephrectomy when compared to R.E.N.A.L.
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Khandwala K, Khan DB, Hussain Z, Sajjad N, Alvi MI. Interobserver Reliability of the RENAL Nephrometry Scoring System: Experience From a Developing Nation. Cureus 2020; 12:e11451. [PMID: 33329950 PMCID: PMC7733781 DOI: 10.7759/cureus.11451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Introduction The RENAL (radius, exophytic/endophytic properties, nearness of tumor to the collecting system or sinus in millimeters, anterior/posterior, location relative to polar lines) nephrometry score (RENAL-NS) has been described as a structured and quantifiable method to describe a renal tumor’s relevant anatomic features as they relate to the complexity of the lesion. We aim to evaluate a tumor’s RENAL-NS and to assess the reproducibility of the score among different observers. Methods This retrospective study included 49 patients diagnosed with renal cell carcinoma (RCC) who had complete computed tomography (CT) data, RENAL-NS, and histopathology results. All patients underwent renal surgery/intervention at our center between January 2008 and December 2018. The radius of the lesion, exophytic/endophytic properties, nearness to the collecting system, anterior or posterior description, and location relative to the polar lines was used to calculate the score. Tumor complexity was graded as low, intermediate, or high. Two body imaging radiologists evaluated the data independently. Results Interobserver agreement for each of the RENAL-NS parameters, respectively, and overall complexity was calculated. The total agreement was 82%, 51%, 84%, 69%, 73%, and 90%, corresponding to Kappa values of 0.72, 0.33, 0.44, 0.49, 0.58, and 0.83, respectively. The radius, nearness to the collecting system, and total complexity showed the best agreement. Exophytic properties of the lesion showed the least agreement. For cases that were discordant in terms of the final score, no major implications in surgical planning were observed. Conclusion The results of this study show that the RENAL-NS is a useful tool to assess the anatomical features of renal tumors and it is easily reproducible, even for less experienced radiologists in a developing nation.
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Affiliation(s)
| | - Dawar B Khan
- Radiology, Aga Khan University Hospital, Karachi, PAK
| | | | - Nida Sajjad
- Radiology, Aga Khan University Hospital, Karachi, PAK
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Haifler M, Lask A, Gal J, Verhovsky G, Kord E, Zisman A. Interobserver Agreement of the Estimated Contact Surface Area System for Renal Masses. Clin Genitourin Cancer 2019; 17:e802-e805. [PMID: 31151927 DOI: 10.1016/j.clgc.2019.04.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 04/30/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND Nephrometry scores have been designed to assist in standardization of renal masses before nephron-sparing surgery. Estimated contact surface area (eCSA) has been recently described. However, its reproducibility between raters has not been rigorously explored. Our aim was to examine the reproducibility of eCSA and Radius, Exophytic, Nearness, Anterior, Line (RENAL) score (RS) nephrometry systems for renal masses by studying the interobserver agreement between 4 raters. MATERIALS AND METHODS We reviewed the cross-sectional images (computed tomography, magnetic resonance imaging) of patients who underwent nephron-sparing surgery (open, laparoscopic, and robotic). Four urologists independently scored the renal tumors according to the eCSA and RS systems. Scoring was done separately for each nephrometry system. Interobserver agreement was assessed for total scores and separate components of each system by calculating the intraclass correlation coefficient (ICC). RESULTS Ninety patients were scored to achieve power of 83% with α = 0.05. eCSA and RS demonstrated excellent interobserver agreement (ICC = 0.89 for both). The radius component of eCSA and RS had the highest ICC (0.97 and 0.9, respectively) compared with the other components. Location and anterior/posterior components of RS showed poor interobserver correlation (ICC = 0.69 and 0.50, respectively). Maximal difference in RS complexity group assignment was 1 of 43 (47.8%) of cases. CONCLUSION eCSA has excellent interobserver agreement, similar to RS. Directly measurable anatomic variables have better interobserver correlation compared with qualitative variables. These results strengthen the applicability of eCSA as a surgical complexity metric for renal surgery.
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Affiliation(s)
- Miki Haifler
- Department of Urology, Shamir (Assaf Harrofeh) Medical Center, Affiliated with Tel-Aviv University, Tzrifin, Israel.
| | - Avigal Lask
- Department of Urology, Shamir (Assaf Harrofeh) Medical Center, Affiliated with Tel-Aviv University, Tzrifin, Israel
| | - Jonathan Gal
- Department of Urology, Shamir (Assaf Harrofeh) Medical Center, Affiliated with Tel-Aviv University, Tzrifin, Israel
| | - Guy Verhovsky
- Department of Urology, Shamir (Assaf Harrofeh) Medical Center, Affiliated with Tel-Aviv University, Tzrifin, Israel
| | - Eyal Kord
- Department of Urology, Shamir (Assaf Harrofeh) Medical Center, Affiliated with Tel-Aviv University, Tzrifin, Israel
| | - Amnon Zisman
- Department of Urology, Shamir (Assaf Harrofeh) Medical Center, Affiliated with Tel-Aviv University, Tzrifin, Israel
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Zhang ZY, Pan X, Fan Y, Shen C, Yu W, Han WK, Lin J, Wang G, Song Y, Zhao Z, Hao JR, Li XS, Wang H, Wang XY, Zhang XC, Zhou LQ. DDD score for renal tumor: An intuitive and comprehensive anatomical scoring system to access the outcomes of retroperitoneal laparoscopic partial nephrectomy. Int J Urol 2019; 26:451-456. [PMID: 30669176 DOI: 10.1111/iju.13903] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 12/09/2018] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To present a DDD scoring system in assessing the complexity and outcomes of retroperitoneoscopic nephron-sparing surgery for kidney tumor. METHODS We retrospectively evaluated 232 patients who underwent retroperitoneoscopic nephron-sparing surgery between January 2013 and September 2017 for a renal tumor. Both the DDD score and RENAL score were used to classify the tumors. The DDD score consisted of the maximal tumor diameter inside the kidney, the maximal tumor depth into the medulla or collecting system and the minimal distance from the tumor to the main renal vessels. RESULTS The DDD scoring systems were significantly associated with warm ischemia time (P = 0.007) and estimated blood loss (P = 0.017). There was an insignificant positive correlation between the DDD score and the operative time (P = 0.051). Meanwhile, the RENAL score had a significant correlation with the decreasing value of the estimated glomerular filtration rate. Patients with high or moderate DDD scores had a 13.6-fold or 8.4-fold risk of overall complications than those with low DDD scores, respectively (all P < 0.05). As for RENAL score, patients with moderate scores had a 2.9-fold risk of overall complications compared with patients in the low scores group (P = 0.004). In the receiver operating characteristic curve analysis, the DDD score had the greatest area under the curve for overall complications (area under the curve 0.625, P = 0.009), which was more than the RENAL score (area under the curve 0.620, P = 0.013). CONCLUSIONS The DDD score is an intuitive renal tumor scoring system that is more effective than the RENAL score in complexity assessment, and marginally better in prediction of the risk of overall complications of retroperitoneal laparoscopic nephron-sparing surgery.
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Affiliation(s)
- Zhong-Yuan Zhang
- Department of Urology, Peking University First Hospital, Institute of Urology, National Urological Cancer Center, Peking University, Beijing, China
| | - Xi Pan
- Department of Urology, Peking University First Hospital, Institute of Urology, National Urological Cancer Center, Peking University, Beijing, China
| | - Yu Fan
- Department of Urology, Peking University First Hospital, Institute of Urology, National Urological Cancer Center, Peking University, Beijing, China
| | - Cheng Shen
- Department of Urology, Peking University First Hospital, Institute of Urology, National Urological Cancer Center, Peking University, Beijing, China
| | - Wei Yu
- Department of Urology, Peking University First Hospital, Institute of Urology, National Urological Cancer Center, Peking University, Beijing, China
| | - Wen-Ke Han
- Department of Urology, Peking University First Hospital, Institute of Urology, National Urological Cancer Center, Peking University, Beijing, China
| | - Jian Lin
- Department of Urology, Peking University First Hospital, Institute of Urology, National Urological Cancer Center, Peking University, Beijing, China
| | - Gang Wang
- Department of Urology, Peking University First Hospital, Institute of Urology, National Urological Cancer Center, Peking University, Beijing, China
| | - Yi Song
- Department of Urology, Peking University First Hospital, Institute of Urology, National Urological Cancer Center, Peking University, Beijing, China
| | - Zheng Zhao
- Department of Urology, Peking University First Hospital, Institute of Urology, National Urological Cancer Center, Peking University, Beijing, China
| | - Jin-Rui Hao
- Department of Urology, Peking University First Hospital, Institute of Urology, National Urological Cancer Center, Peking University, Beijing, China
| | - Xue-Song Li
- Department of Urology, Peking University First Hospital, Institute of Urology, National Urological Cancer Center, Peking University, Beijing, China
| | - He Wang
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Xiao-Ying Wang
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Xiao-Chun Zhang
- Department of Urology, Peking University First Hospital, Institute of Urology, National Urological Cancer Center, Peking University, Beijing, China
| | - Li-Qun Zhou
- Department of Urology, Peking University First Hospital, Institute of Urology, National Urological Cancer Center, Peking University, Beijing, China
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Srivastava A, Ficarra V, Kutikov A. The Alphabet Soup of Modern Nephrometry Systems. Eur Urol Oncol 2018; 1:435-436. [PMID: 31158084 DOI: 10.1016/j.euo.2018.08.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 08/25/2018] [Indexed: 01/20/2023]
Affiliation(s)
- Abhishek Srivastava
- Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, USA
| | | | - Alexander Kutikov
- Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, USA.
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Sharma AP, Mavuduru RS, Bora GS, Devana SK, Palani K, Lal A, Kakkar N, Singh SK, Mandal AK. Comparison of RENAL, PADUA, and C-index scoring systems in predicting perioperative outcomes after nephron sparing surgery. Indian J Urol 2018; 34:51-55. [PMID: 29343913 PMCID: PMC5769250 DOI: 10.4103/iju.iju_247_17] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Introduction and Objective The RENAL, PADUA and centrality index (C-index) nephrometry scoring systems (SS) have been individually evaluated for their role in predicting trifecta outcomes after nephron-sparing surgery (NSS). However, there is little data on their comparative superiority. The present study was designed to evaluate the predictive value of three SS and to assess interobserver reliability. Materials and Methods Fifty patients undergoing NSS at our center between January 2014 and April 2016 were included in the study. The demographic details were noted. Images (computed tomography [CT] scans or magnetic resonance imaging) were reviewed by a urologist and a radiologist independently and RENAL, PADUA, and C-index were calculated. The correlation between these scoring system and trifecta outcomes were calculated. Results The RENAL and PADUA score did not correlate with any of the perioperative parameters. However, C-index had a significant correlation with operative time (OT) (P = 0.02) and trifecta outcomes (P < 0.05). There was an excellent concordance between the two observers in scoring the RENAL score (α = 0.915; intraclass correlation coefficient [ICC] = 0.814) and PADUA score (α = 0.816; ICC = 0.689 [P < 0.001]). There was lesser although acceptable concordance in the calculation of C-index (ICC -0.552; α -0.711). Conclusions There is good correlation among all the 3 SS. C-index has lower reproducibility due to difficult mathematical calculation but correlated best with trifecta outcomes.
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Affiliation(s)
- Aditya P Sharma
- Department of Urology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Girdhar Singh Bora
- Department of Urology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sudheer K Devana
- Department of Urology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kiruthika Palani
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Anupam Lal
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Nandita Kakkar
- Department of Pathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shrawan K Singh
- Department of Urology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Arup K Mandal
- Department of Urology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Bertrand LA, Thomas LJ, Li P, Buchta CM, Boi SK, Orlandella RM, Brown JA, Nepple KG, Norian LA. Obesity as defined by waist circumference but not body mass index is associated with higher renal mass complexity. Urol Oncol 2017; 35:661.e1-661.e6. [PMID: 28797586 DOI: 10.1016/j.urolonc.2017.06.058] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 05/04/2017] [Accepted: 06/21/2017] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Obesity, typically defined as a body mass index (BMI)≥30kg/m2, is an established risk factor for renal cell carcinoma (RCC) but is paradoxically linked to less advanced disease at diagnosis and improved outcomes. However, BMI has inherent flaws, and alternate obesity-defining metrics that emphasize abdominal fat are available. We investigated 3 obesity-defining metrics, to better examine the associations of abdominal fat vs. generalized obesity with renal tumor stage, grade, or R.E.N.A.L. nephrometry score. METHODS AND MATERIALS In a prospective cohort of 99 subjects with renal masses undergoing resection and no evidence of metastatic disease, obesity was assessed using 3 metrics: body mass index (BMI), radiographic waist circumference (WC), and retrorenal fat (RRF) pad distance. R.E.N.A.L. nephrometry scores were calculated based on preoperative CT or MRI. Univariate and multivariate analyses were performed to identify associations between obesity metrics and nephrometry score, tumor grade, and tumor stage. RESULTS In the 99 subjects, surgery was partial nephrectomy in 51 and radical nephrectomy in 48. Pathology showed benign masses in 11 and RCC in 88 (of which 20 had stage T3 disease). WC was positively correlated with nephrometry score, even after controlling for age, sex, race, and diabetes status (P = 0.02), whereas BMI and RRF were not (P = 0.13, and P = 0.57, respectively). WC in stage T2/T3 subjects was higher than in subjects with benign masses (P = 0.03). In contrast, subjects with Fuhrman grade 1 and 2 tumors had higher BMI (P<0.01) and WC (P = 0.04) than subjects with grade 3 and 4 tumors. CONCLUSIONS Our data suggest that obesity measured by WC, but not BMI or RRF, is associated with increased renal mass complexity. Tumor Fuhrman grade exhibited a different trend, with both high WC and BMI associated with lower-grade tumors. Our findings indicate that WC and BMI are not interchangeable obesity metrics. Further evaluation of RCC-specific outcomes using WC vs. BMI is warranted to better understand the complex relationship between general vs. abdominal obesity and RCC characteristics.
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Affiliation(s)
- Laura A Bertrand
- Department of Urology, The University of Iowa Carver College of Medicine, Iowa City, IA
| | - Lewis J Thomas
- Department of Urology, The University of Iowa Carver College of Medicine, Iowa City, IA
| | - Peng Li
- Department of Biostatistics, School of Public Health, The University of Alabama at Birmingham, Birmingham, AL
| | - Claire M Buchta
- Department of Urology, The University of Iowa Carver College of Medicine, Iowa City, IA
| | - Shannon K Boi
- Graduate Biomedical Sciences, University of Alabama at Birmingham, Birmingham, AL
| | - Rachael M Orlandella
- Graduate Biomedical Sciences, University of Alabama at Birmingham, Birmingham, AL
| | - James A Brown
- Department of Urology, The University of Iowa Carver College of Medicine, Iowa City, IA; Holden Comprehensive Cancer Center, The University of Iowa Carver College of Medicine, Iowa City, IA
| | - Kenneth G Nepple
- Department of Urology, The University of Iowa Carver College of Medicine, Iowa City, IA; Holden Comprehensive Cancer Center, The University of Iowa Carver College of Medicine, Iowa City, IA
| | - Lyse A Norian
- Department of Nutrition Sciences, The University of Alabama at Birmingham School of Health Professions, Birmingham, AL; Comprehensive Cancer Center, The University of Alabama at Birmingham, Birmingham, AL.
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Vilaseca RM, Westphalen AC, Reis HF, Zogbi OS, Silva GE, Dos Reis RB, Muglia VF. Reproducibility and interobserver agreement of the R.E.N.A.L. nephrometry score: focus on imaging features. Radiol Bras 2017; 50:7-12. [PMID: 28298726 PMCID: PMC5347496 DOI: 10.1590/0100-3984.2015.0174] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE To investigate the reproducibility and interobserver agreement for R.E.N.A.L. nephrometry scoring system. MATERIALS AND METHODS Two independent radiologists retrospectively analyzed 46 consecutive patients with renal masses, between 2008 and 2012, using the R.E.N.A.L. nephrometry score (RENAL-NS), which is based on the evaluation of five anatomical features of the tumor, as evaluated with computed tomography or magnetic resonance imaging: Radius, Exophytic/endophytic properties, Nearness to the collecting system, Anterior or posterior descriptor, and Location relative to the polar line. Tumor complexity was graded as low, intermediate, or high. The interobserver agreement was calculated for the total score and for the score for each parameter. Surgical excision of the tumors was used as the standard of reference. RESULTS The interobserver agreement for each of the RENAL-NS parameters, respectively, a hilar location, and the total score was 98%, 80%, 100%, 89%, 85%, 89%, and 93% of patients, corresponding to kappa values of 0.96, 0.65, 1.00, 0.75, 0.72, 0.78, and 0.88, respectively. The Nearness, Radius, and total score showed the best agreement. For the cases that were discordant in terms of the final score, no major implications in surgical planning were observed. CONCLUSION The RENAL-NS is a structured, useful system to assess the anatomical features of renal tumors. It is easily applicable and reproducible, even for less experienced radiologists.
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Affiliation(s)
- Richard Mast Vilaseca
- MD, Attending Radiologist, Radiology Department - Abdominal Imaging, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Antonio Carlos Westphalen
- MD, PhD, Associate Professor of Radiology, Radiology and Biomedical Engineering, University of California at San Francisco (UCSF), San Francisco, CA, USA
| | - Henrique Ferreira Reis
- MD, Attending Radiologist, Internal Medicine Department - Imaging Division, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil
| | - Orlando Salomão Zogbi
- MD, Attending Radiologist, Internal Medicine Department - Imaging Division, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil
| | - Gyl Eanes Silva
- MD, PhD, Assistant Professor, Department of Pathology, Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil
| | - Rodolfo Borges Dos Reis
- MD, PhD, Assistant Professor, Department of Surgery - Urology Division, Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil
| | - Valdair Francisco Muglia
- MD, PhD, Associate Professor, Department of Radiology, Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil
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Acosta Ruiz V, Lönnemark M, Brekkan E, Dahlman P, Wernroth L, Magnusson A. Predictive factors for complete renal tumor ablation using RFA. Acta Radiol 2016; 57:886-93. [PMID: 26452975 DOI: 10.1177/0284185115605681] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 08/02/2015] [Indexed: 01/20/2023]
Abstract
BACKGROUND Radiofrequency ablation (RFA) can be used to treat renal masses in patients where surgery is preferably avoided. As tumor size and location can affect ablation results, procedural planning needs to identify these factors to limit treatment to a single session and increase ablation success. PURPOSE To identify factors that may affect the primary efficacy of complete renal tumor ablation with radiofrequency after a single session. MATERIAL AND METHODS Percutaneous RFA (using an impedance based system) was performed using computed tomography (CT) guidance. Fifty-two renal tumors (in 44 patients) were retrospectively studied (median follow-up, 7 months). Data collection included patient demographics, tumor data (modified Renal Nephrometry Score, histopathological diagnosis), RFA treatment data (electrode placement), and follow-up results (tumor relapse). Data were analyzed through generalized estimating equations. RESULTS Primary efficacy rate was 83%. Predictors for complete ablation were optimal electrode placement (P = 0.002, OR = 16.67) and increasing distance to the collecting system (P = 0.02, OR = 1.18). Tumor size was not a predictor for complete ablation (median size, 24 mm; P = 0.069, OR = 0.47), but all tumors ≤2 cm were completely ablated. All papillary tumors and oncocytomas were completely ablated in a single session; the most common incompletely ablated tumor type was clear cell carcinoma (6 of 9). CONCLUSION Optimal electrode placement and a long distance from the collecting system are associated with an increased primary efficacy of renal tumor RFA. These variables need to be considered to increase primary ablation success. Further studies are needed to evaluate the effect of RFA on histopathologically different renal tumors.
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Affiliation(s)
| | - Maria Lönnemark
- Department of Radiology, University Hospital, Uppsala, Sweden
| | - Einar Brekkan
- Department of Urology, University Hospital, Uppsala, Sweden
| | - Pär Dahlman
- Department of Radiology, University Hospital, Uppsala, Sweden
| | - Lisa Wernroth
- Department of Medical Sciences, Molecular Epidemiology, University Hospital, Uppsala, Sweden
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Shin SJ, Ko KJ, Kim TS, Ryoo HS, Sung HH, Jeon HG, Jeong BC, Seo SI, Lee HM, Choi HY, Jeon SS. Trends in the Use of Nephron-Sparing Surgery over 7 Years: An Analysis Using the R.E.N.A.L. Nephrometry Scoring System. PLoS One 2015; 10:e0141709. [PMID: 26599436 PMCID: PMC4657937 DOI: 10.1371/journal.pone.0141709] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 10/12/2015] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE To analyze trends in the use of partial nephrectomy, we evaluated which individual factors of renal nephrometry score (RNS) influenced the operative approach bi-annually from 2008 to 2014. MATERIALS AND METHODS We performed a retrospective review of renal cell carcinoma treated by surgery in 2008, 2010, 2012, and 2014. The complexity of renal masses was measured using the R.E.N.A.L. nephrometry scoring system with CT or MRI. Group comparison in terms of operation year and surgical type (partial nephrectomy versus radical nephrectomy) was performed. We developed a nomogram to quantitate the likelihood of selecting partial nephrectomy over radical nephrectomy. RESULTS A total of 1106 cases (237 in 2008, 225 in 2010, 292 in 2012, and 352 in 2014) were available for the study. Over the study period, the proportion of partial nephrectomies performed increased steadily from 21.5% in 2008 to 66.5% in 2014 (p < 0.05). Furthermore, use of partial nephrectomy increased steadily in all RNS complexity groups (low, moderate, and high) (p < 0.05). In the analysis of individual components of RNS, values of the R and N components increased statistically by year in the partial nephrectomy group (p < 0.05). Average AUC was 0.920. CONCLUSIONS The proportion of partial nephrectomies performed sharply increased over the study period. Additionally, over the study period, more partial nephrectomies were performed for renal masses of larger size and closer to the collecting system and main renal vessels. A nomogram developed based on this recent data set provides significant predictive value for surgical decision making.
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Affiliation(s)
- Seung Jea Shin
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kwang Jin Ko
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae Sun Kim
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Soo Ryoo
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Hwan Sung
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hwang Gyun Jeon
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byong Chang Jeong
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seong Il Seo
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Moo Lee
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Han Yong Choi
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seong Soo Jeon
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Spaliviero M, Poon BY, Karlo CA, Guglielmetti GB, Di Paolo PL, Beluco Corradi R, Martin-Malburet AG, Campos-Juanatey F, Escudero-Fontano E, Sjoberg DD, Russo P, Coleman JA, Akin O, Touijer KA. An Arterial Based Complexity (ABC) Scoring System to Assess the Morbidity Profile of Partial Nephrectomy. Eur Urol 2015; 69:72-9. [PMID: 26298208 DOI: 10.1016/j.eururo.2015.08.008] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 08/05/2015] [Indexed: 01/20/2023]
Abstract
BACKGROUND Tumor characteristics affect surgical complexity and outcomes of partial nephrectomy (PN). OBJECTIVE To develop an Arterial Based Complexity (ABC) scoring system to predict morbidity of PN. DESIGN, SETTING, AND PARTICIPANTS Four readers independently scored contrast-enhanced computed tomography images of 179 patients who underwent PN. INTERVENTION Renal cortical masses were categorized by the order of vessels needed to be transected/dissected during PN. Scores of 1, 2, 3S, or 3H were assigned to tumors requiring transection of interlobular and arcuate arteries, interlobar arteries, segmental arteries, or in close proximity of the renal hilum, respectively during PN. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Interobserver variability was assessed with kappa values and percentage of exact matches between each pairwise combination of readers. Linear regression was used to evaluate the association between reference scores and ischemia time, estimated blood loss, and estimated glomerular filtration rates at 6 wk and 6 mo after surgery adjusted for baseline estimated glomerular filtration rate. Fisher's exact test was used to test for differences in risk of urinary fistula formation by reference category assignment. RESULTS AND LIMITATIONS Pairwise comparisons of readers' score assignments were significantly correlated (all p<0.0001); average kappa = 0.545 across all reader pairs. The average proportion of exact matches was 69%. Linear regression between the complexity score system and surgical outcomes showed significant associations between reference category assignments and ischemia time (p<0.0001) and estimated blood loss (p=0.049). Fisher's exact test showed a significant difference in risk of urinary fistula formation with higher reference category assignments (p=0.028). Limitations include use of a single institutional cohort to evaluate our system. CONCLUSIONS The ABC scoring system for PN is intuitive, easy to use, and demonstrated good correlation with perioperative morbidity. PATIENT SUMMARY The ABC scoring system is a novel anatomy-reproducible tool developed to help patients and doctors understand the complexity of renal masses and predict the outcomes of kidney surgery.
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Affiliation(s)
- Massimiliano Spaliviero
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Bing Ying Poon
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Christoph A Karlo
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Giuliano B Guglielmetti
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Pier Luigi Di Paolo
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Renato Beluco Corradi
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | | | - Daniel D Sjoberg
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Paul Russo
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jonathan A Coleman
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Oguz Akin
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Karim A Touijer
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Benadiba S, Verin AL, Pignot G, Bessede T, Drai J, Bahi R, Toussile W, Rocher L, Patard JJ. Are urologists and radiologists equally effective in determining the RENAL Nephrometry score? Ann Surg Oncol 2014; 22:1618-24. [PMID: 25384701 DOI: 10.1245/s10434-014-4152-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Indexed: 12/23/2022]
Abstract
BACKGROUND The RENAL nephrometry score (RNS) allows description of the anatomy and the complexity of renal masses. This study aimed to investigate the interobserver reproducibility of the RNS between a radiologist and a urologist. METHODS The computed tomography (CT) scans of patients undergoing partial nephrectomy in the authors' department between June 2010 and June 2013 were analyzed for determination of the RNS by a urologist and a radiologist blinded to the medical records. Cohen's kappa coefficient was used for interobserver reproducibility assessment. Correlations with per- and postoperative complication rates and renal function were assessed. RESULTS The study included 52 consecutive patients with a mean age of 55 years. The average score was 7.4 ± 1.7 for the urologist and 7.3 ± 1.5 for the radiologist. The Cohen's kappa was 0.81 for R, 0.47 for E, 0.63 for N, 0.28 for A, and 0.21 for L. The Pearson's coefficient for the total RNS was 0.70. The operative time and the occurrence of major complications were significantly correlated with the complexity assessed by the score of both observers. In the univariate analysis, the RNS, the American Society of Anesthesiologists score, and the patient's age were significantly associated with major complication rates. In the multivariate analysis, the RNS remained significantly associated with major complications. No significant difference in postoperative renal function according to complexity group was found by either the urologist or the radiologist. CONCLUSIONS The reproducibility of the RNS between the radiologist and the urologist was not very good, especially for some items referring to the location of the tumor, although the major complication rates were significantly associated with the RNS for both observers.
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Affiliation(s)
- Steeve Benadiba
- Urology Department, Bicetre Hospital, University Paris XI, Le Kremlin Bicêtre, France
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Moreno-Alarcón C, Ramírez-Backhaus M, Pelechano-Gómez P, Ortiz-Rodríguez IM, Rubio-Briones J, Rodríguez-Torreblanca C, Solsona-Narbón E. Nephrometry scores: interobserver reproducibility and perioperative factors prediction. Actas Urol Esp 2014; 38:523-9. [PMID: 24703257 DOI: 10.1016/j.acuro.2014.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Revised: 01/25/2014] [Accepted: 02/02/2014] [Indexed: 01/20/2023]
Abstract
OBJECTIVES To validate the relation of the nephrometry scores in a series of patients who underwent partial nephrectomy with perioperative parameters and the urologist-radiologist reproducibility. MATERIAL AND METHODS A retrospective study of open and laparoscopic partial nephrectomy patients performed between 2005 and 2012 registered in prospective filled out database. An urologist and a radiologist calculated the R.E.N.A.L., PADUA and C-index for 86 patients. We carried out a comparative study of the results using the Spearman and Pearson correlation indexes. RESULTS Distribution according to the complexity of the tumors with the RENAL calculation was: 42 (49%) low, 35 (41%) moderated and 9 (11%) high complexity. According to PADUA: 35 (41%) low complexity, 32 (37%) intermediate and 19 (22%) high. No statistically significant correlation was found for the appearance of operative complications and the pathology results in case of RENAL and PADUA. A correlation was found in the case of PADUA in relation to the warm ischemia time. Positive correlation according to Spearman's index was found in RENAL, PADUA and C-index between urologist and radiologist evaluations. CONCLUSIONS Nephrometry scores can be a useful tool to plan the surgical technique or approach. However, it is not clear if they are really predictors of surgical or pathologic parameters. The correlation between the urologist and radiologist seems to be sufficient to recommend their use by both specialties.
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Affiliation(s)
- C Moreno-Alarcón
- Servicio de Urología, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España.
| | - M Ramírez-Backhaus
- Servicio de Urología, Fundación Instituto Valenciano de Oncología, Valencia, España
| | - P Pelechano-Gómez
- Servicio de Radiodiagnóstico, Fundación Instituto Valenciano de Oncología, Valencia, España
| | - I M Ortiz-Rodríguez
- Departamento de Matemática Aplicada, Universidad de Almería, Almería, España
| | - J Rubio-Briones
- Servicio de Urología, Fundación Instituto Valenciano de Oncología, Valencia, España
| | | | - E Solsona-Narbón
- Servicio de Urología, Fundación Instituto Valenciano de Oncología, Valencia, España
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15
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Spaliviero M, Poon BY, Aras O, Di Paolo PL, Guglielmetti GB, Coleman CZ, Karlo CA, Bernstein ML, Sjoberg DD, Russo P, Touijer KA, Akin O, Coleman JA. Interobserver variability of R.E.N.A.L., PADUA, and centrality index nephrometry score systems. World J Urol 2014; 33:853-8. [PMID: 25149471 DOI: 10.1007/s00345-014-1376-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 07/31/2014] [Indexed: 01/20/2023] Open
Abstract
PURPOSE To assess interobserver variability of R.E.N.A.L., preoperative aspects and dimensions used for an anatomical classification system (PADUA), and centrality index (C-Index) systems among observers with varying degrees of clinical experience and each system's subscale correlation with surgical outcome metrics. METHODS Computed tomography images of 90 patients who underwent open, laparoscopic, or robot-assisted laparoscopic partial nephrectomy were scored by one radiology fellow, two urology fellows, one radiology resident, and one secondary school student. Agreement among readers was determined calculating intraclass correlation coefficients. Associations between radiology fellow scores (reference standard as reader with greatest clinical experience), ischemia time, and percent change in postoperative estimated glomerular filtration rate (eGFR) were evaluated using Spearman's correlation. RESULTS Agreement using C-Index method (ICC = 0.773) was higher than with PADUA (ICC = 0.677) or R.E.N.A.L (ICC = 0.660). Agreement between reference and secondary school student was lower than with other physicians, although the differences were not statistically significant. The reference's scores were significantly (p < 0.05) associated with ischemia time on all three scoring systems and with percent change in eGFR at 6 weeks using C-Index (p = 0.016). Tumor size, nearness to sinus, and location relative to polar lines (R.E.N.A.L.) and tumor size, renal sinus involvement, and collecting system involvement (PADUA) correlated with ischemia time (all p ≤ 0.001). No R.E.N.A.L. or PADUA subscales significantly correlated with percent change in postoperative eGFR. CONCLUSIONS Clinical experience reduces interobserver variability of existing nephrometry systems though not significantly and less so when using directly measureable anatomic variables. Consistently, only measures of tumor size and distance to intrarenal structures were useful in predicting clinically relevant outcomes.
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Affiliation(s)
- Massimiliano Spaliviero
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
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16
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Cost NG, DeFoor WR, Crotty EJ, Geller JI. The initial experience with RENAL Nephrometry in children, adolescents, and young adults with renal tumors. Pediatr Blood Cancer 2014; 61:1434-9. [PMID: 24610879 DOI: 10.1002/pbc.25027] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 02/17/2014] [Indexed: 01/20/2023]
Abstract
BACKGROUND No standardized manner exits to objectively compare renal tumor complexity in children and adolescents. However, the RENAL Nephrometry scoring system has been recently developed in adults and shown to predict tumor complexity and correlate with clinical outcomes. Thus, the study objective was to evaluate RENAL Nephrometry tumor score in a population of children, adolescents, and young adults and correlate it with tumor features and pathology. METHODS Patients at the study institution who underwent attempted renal tumor resection from 2002 to 2012, and had pre-operative imaging available for scoring were retrospectively reviewed. A Nephrometry score for each affected kidney was calculated separately by two blinded reviewers and the final score was based on consensus review. Tumor characteristics and oncologic outcomes were compared between the low-, moderate-, and high-complexity masses. RESULTS Sixty-five patients and 67 kidneys met study criteria. This included: 5 (7.5%) low-complexity, 11 (16.4%) moderate-complexity, and 51 (76.1%) high-complexity lesions. In comparing the clinical and pathologic features between groups, it was observed that less complex masses were observed in older patients, were more commonly managed with nephron-sparing surgery, and more often represented renal cell carcinoma (RCC) and other non-Wilms tumor pathology. No statistically significant correlation was observed between tumor complexity score and blood loss, operative time, transfusion requirement, positive margins or tumor rupture. CONCLUSION In general, renal lesions in this population are highly complex. In its current form, RENAL Nephrometry appears most useful in evaluating tumor complexity in RCC and masses in older children and adolescents.
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Affiliation(s)
- Nicholas G Cost
- Division of Urology, University of Colorado School of Medicine, Aurora, Colorado; Division of Urology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Tay MHW, Thamboo TP, Wu FMW, Zhaojin C, Choo TB, Ramaan L, Tiong HY. High R.E.N.A.L. Nephrometry scores are associated with pathologic upstaging of clinical T1 renal-cell carcinomas in radical nephrectomy specimens: implications for nephron-sparing surgery. J Endourol 2014; 28:1138-42. [PMID: 24810993 DOI: 10.1089/end.2014.0123] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND AND PURPOSE The R.E.N.A.L. Nephrometry Score (RNS) was developed to standardize the reporting of anatomic information of a renal mass. This study aimed to identify the association of preoperative clinical and tumor features assessed by the RNS with pathologic upstaging of clinical T1 renal-cell carcinomas (RCCs) in complete en bloc radical nephrectomy (RN) specimens. PATIENTS AND METHODS A review was performed for 65 consecutive patients (2005-2013) who underwent RNs for a unilateral clinical T1N0M0 RCC. The RNS was measured in all patients based on preoperative CT scans. Pathologic review was performed to identify patients with final pathologic upstaging. Associations were assessed with the Fisher exact test, Student t test, and Wilcoxon rank sum test. RESULTS Of the 65 patients (41 male, mean age 59 years), 4 (6%) patients were upstaged to pT2 and 16 (25%) were upstaged to pT3a and above in the final histologic evaluation. Upstaged patients were not significantly different from those without in terms of age, sex, race, surgical approach, side of surgery, Fuhrman grade, and histologic cell type. Independent tumor features associated with pathologic upstaging were (R) tumor diameter (P=0.021), and (L) central location within polar lines (P=0.010). Tumors that were upstaged had a higher median total RNS than those without (10 vs 9, P=0.010). Complex tumors, with RNS≥10, were associated with significantly increased risk of upstaging compared with low and intermediate complexity categories (RNS<10) (relative risk=2.56, 95% confidence interval 1.22-5.37, P=0.014). CONCLUSIONS A higher RNS was associated with an increased risk of upstaging in clinical T1 cancers, predominantly from perinephric or sinus fat invasion in RN pathologic specimens. This may have implications on the selection of surgical option for the clinical T1 renal mass.
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Affiliation(s)
- Melissa H W Tay
- 1 Department of Urology, National University Health System , Singapore
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Monn MF, Gellhaus PT, Masterson TA, Patel AA, Tann M, Cregar DM, Boris RS. R.E.N.A.L. Nephrometry scoring: how well correlated are urologist, radiologist, and collaborator scores? J Endourol 2014; 28:1006-10. [PMID: 24708445 DOI: 10.1089/end.2014.0166] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
PURPOSE R.E.N.A.L. Nephrometry Score (NS) is an imaging-based (CT/MRI) scoring system commonly used by urologists to standardize the reporting of renal masses by enabling quantification of anatomical characteristics. We sought to examine the inter-rater correlation of NS between urologists, radiologists, and tumor-board collaborators. METHODS We identified adult patients undergoing partial or radical nephrectomy over 10 years (n=2450). Patients with autosomal dominant polycystic kidney disease (ADPKD), metastatic disease, masses >10 cm, and studies in which the study urologists or radiologists partook in patient care were excluded. Preoperative imaging was evaluated and patients with multiphasic CT available were included. Scans were provided to the reviewers to evaluate with a R.E.N.A.L. nephrometry questionnaire. Results were analyzed using kappa correlation coefficients. RESULTS One hundred twenty patients met inclusion criteria with mean age of 59.5 years. The majority of cases were partial nephrectomies (72%). Eighty-five percent of the tumors were malignant, with 26% having high-grade histology. The mean (standard deviation) overall NS was 6.8 (1.9) with fair correlation among reviewers (κ=0.222). Collaborators had the highest inter-rater correlation, ranging from 0.41 to 0.84 for NS component scores, compared with 0.42-0.85 for radiologists and 0.36-0.86 for urologists. "R" scores were best correlated (κ>0.8). NS correlation ranged between 0.16 and 0.31 for the groups while the NS complexity category correlation ranged between 0.50 and 0.61. CONCLUSIONS Despite being naive to NS, inter-radiologist scoring patterns were better correlated than inter-urologist. The urologist and radiologist collaborating in tumor board showed the highest agreement, suggesting that a multidisciplinary approach in the characterization of renal masses may provide benefit to patient management.
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Affiliation(s)
- M Francesca Monn
- 1 Department of Urology, Indiana University School of Medicine , Indianapolis, Indiana
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Wang L, Wu Z, Ye H, Li M, Sheng J, Liu B, Xiao L, Yang Q, Sun Y. Correlations of Tumor Size, RENAL, Centrality Index, Preoperative Aspects and Dimensions Used for Anatomical, and Diameter-axial–polar Scoring With Warm Ischemia Time in a Single Surgeon's Series of Robotic Partial Nephrectomy. Urology 2014; 83:1075-9. [DOI: 10.1016/j.urology.2014.01.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 11/19/2013] [Accepted: 01/01/2014] [Indexed: 10/25/2022]
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Lagerveld BW, Brenninkmeijer M, van der Zee JA, van Haarst EP. Can RENAL and PADUA Nephrometry Indices Predict Complications of Laparoscopic Cryoablation for Clinical Stage T1 Renal Tumors? J Endourol 2014; 28:464-71. [DOI: 10.1089/end.2013.0498] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
| | | | | | - Ernst P. van Haarst
- Department of Urology, St. Lucas Andreas Hospital, Amsterdam, The Netherlands
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Oh JH, Rhew HY, Kim TS. Factors Influencing the Operative Approach to Renal Tumors: Analyses According to RENAL Nephrometry Scores. Korean J Urol 2014; 55:97-101. [PMID: 24578804 PMCID: PMC3935077 DOI: 10.4111/kju.2014.55.2.97] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Accepted: 10/02/2013] [Indexed: 01/20/2023] Open
Abstract
Purpose To evaluate the relationship between RENAL nephrometry score (RNS) and operative approach for renal masses. Materials and Methods This study included 206 consecutive patients who underwent renal tumor surgery between January 2008 and October 2012. We divided the patients into four groups by surgical approach: open radical nephrectomy (ORN, 53 patients), laparoscopic radical nephrectomy (LRN, 83 patients), open partial nephrectomy (OPN, 31 patients), and laparoscopic partial nephrectomy (LPN, 39 patients). We retrospectively assessed the RNS for each surgery group and evaluated the relationship between this score and operative approach. Results The mean RNSs of the ORN, LRN, OPN, and LPN groups were 9.75, 8.35, 6.72, and 5.76, respectively. When the RNS was analyzed according to nephron-sparing, the mean RNSs of the RN groups (ORN and LRN) and the PN groups (OPN and LPN) were significantly different (8.89 and 6.09, respectively; p<0.001). All the individual components of the RNS were significantly different between RN and PN. In the RN groups, the criteria for open versus laparoscopic surgery were based on tumor size ('R' score=2.43 for open, 1.54 for laparoscopic, p<0.001) and tumor location relative to the polar line ('L' score=2.55 for open, 2.09 for laparoscopic, p=0.006). In the PN groups, the criteria for open or laparoscopic surgery were based only on exophytic/endophytic property ('E' score=1.87 for open, 1.41 for laparoscopic, p=0.046). Conclusions The RNS was significantly different in all surgery groups. The decision to take a laparoscopic approach was primarily influenced by the R and L scores for RN and by the E score for PN.
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Affiliation(s)
- Jeong Hyun Oh
- Department of Urology, Kosin University Gospel Hospital, Busan, Korea
| | - Hyun Yul Rhew
- Department of Urology, Kosin University Gospel Hospital, Busan, Korea
| | - Taek Sang Kim
- Department of Urology, Kosin University Gospel Hospital, Busan, Korea
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Seideman CA, Gahan J, Weaver M, Olweny EO, Richter M, Chan D, Cadeddu JA. Renal tumour nephrometry score does not correlate with the risk of radiofrequency ablation complications. BJU Int 2013; 112:1121-4. [DOI: 10.1111/bju.12276] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Casey A. Seideman
- Department of Urology; University of Texas Southwestern Medical Center; Dallas TX USA
| | - Jeffrey Gahan
- Department of Urology; University of Texas Southwestern Medical Center; Dallas TX USA
| | - Matthew Weaver
- Department of Urology; University of Texas Southwestern Medical Center; Dallas TX USA
| | - Ephrem O. Olweny
- Department of Urology; University of Texas Southwestern Medical Center; Dallas TX USA
| | - Michael Richter
- Department of Interventional Radiology; University of Texas Southwestern Medical Center; Dallas TX USA
| | - Danny Chan
- Department of Interventional Radiology; University of Texas Southwestern Medical Center; Dallas TX USA
| | - Jeffrey A. Cadeddu
- Department of Urology; University of Texas Southwestern Medical Center; Dallas TX USA
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Zhang ZY, Tang Q, Li XS, Zhang Q, Mayer WA, Wu JY, Yang XD, Zhang XC, Wang XY, Zhou LQ. Clinical analysis of the PADUA and the RENAL scoring systems for renal neoplasms: a retrospective study of 245 patients undergoing laparoscopic partial nephrectomy. Int J Urol 2013; 21:40-4. [PMID: 23675903 DOI: 10.1111/iju.12192] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2013] [Accepted: 04/09/2013] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To investigate the clinical significance of preoperative aspects and dimensions used for anatomic (PADUA) and radius exophytic/endophytic nearness anterior/posterior location (RENAL) scoring systems for renal neoplasms in patients undergoing laparoscopic partial nephrectomy. METHODS A retrospective analysis was carried out on clinical data of 245 Chinese patients with renal neoplasms undergoing laparoscopic partial nephrectomy from June 2008 to June 2012. The perioperative complications and variables, as well as PADUA and RENAL score, were compared. RESULTS The PADUA and RENAL scoring systems were significantly associated with percent change in estimated glomerular filtration rate (P = 0.032 and P = 0.026 respectively), whereas the RENAL scoring system was also significantly associated with warm ischemia time (P = 0.032). On multivariate analysis, both scores were able to predict percent change in estimated glomerular filtration rate (PADUA, P = 0.011; RENAL, P = 0.028). There were no significant associations between the two scoring systems assessed and the occurrence of complications or tumor stage. The correlation between PADUA classification and RENAL nephrometry score was significant (P < 0.0001). Fleiss' generalized kappa was 0.69-0.89 for the various components of the PADUA score and 0.67-0.89 for the RENAL nephrometry components. CONCLUSIONS The PADUA classification and RENAL nephrometry score are comprehensive assessment tools for delineating renal tumor anatomy. The reproducibility of the PADUA and RENAL scores is substantial, but further research is required to evaluate its performance in more accurately predicting operative and patient-related outcomes.
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Affiliation(s)
- Zhong-Yuan Zhang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center
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25
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Okhunov Z, Shapiro EY, Moreira DM, Lipsky MJ, Hillelsohn J, Badani K, Landman J, Kavoussi LR. R.E.N.A.L. Nephrometry Score Accurately Predicts Complications Following Laparoscopic Renal Cryoablation. J Urol 2012; 188:1796-800. [DOI: 10.1016/j.juro.2012.07.028] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2012] [Indexed: 01/20/2023]
Affiliation(s)
- Zhamshid Okhunov
- Arthur Smith Institute for Urology, North Shore-LIJ Hofstra School of Medicine, Hempstead, New York
| | - Edan Y. Shapiro
- Department of Urology, Columbia University Medical Center, New York, New York
| | - Daniel M. Moreira
- Arthur Smith Institute for Urology, North Shore-LIJ Hofstra School of Medicine, Hempstead, New York
| | - Michael J. Lipsky
- Department of Urology, Columbia University Medical Center, New York, New York
| | - Joel Hillelsohn
- Arthur Smith Institute for Urology, North Shore-LIJ Hofstra School of Medicine, Hempstead, New York
| | - Ketan Badani
- Department of Urology, Columbia University Medical Center, New York, New York
| | - Jaime Landman
- Department of Urology, University of California, Irvine, Irvine, California
| | - Louis R. Kavoussi
- Arthur Smith Institute for Urology, North Shore-LIJ Hofstra School of Medicine, Hempstead, New York
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26
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Buethe DD, Moussly S, Lin HY, Yue B, Rodriguez AR, Spiess PE, Sexton WJ. Is the R.E.N.A.L. Nephrometry Scoring System Predictive of the Functional Efficacy of Nephron Sparing Surgery in the Solitary Kidney? J Urol 2012; 188:729-35. [PMID: 22819418 DOI: 10.1016/j.juro.2012.04.115] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2012] [Indexed: 01/20/2023]
Affiliation(s)
- David D. Buethe
- Departments of Genitourinary Oncology and Biostatistics (HYL, BY), H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Sammy Moussly
- Departments of Genitourinary Oncology and Biostatistics (HYL, BY), H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Hui-Yi Lin
- Departments of Genitourinary Oncology and Biostatistics (HYL, BY), H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Binglin Yue
- Departments of Genitourinary Oncology and Biostatistics (HYL, BY), H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Alejandro R. Rodriguez
- Departments of Genitourinary Oncology and Biostatistics (HYL, BY), H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Philippe E. Spiess
- Departments of Genitourinary Oncology and Biostatistics (HYL, BY), H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Wade J. Sexton
- Departments of Genitourinary Oncology and Biostatistics (HYL, BY), H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
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27
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Simmons MN, Hillyer SP, Lee BH, Fergany AF, Kaouk J, Campbell SC. Diameter-Axial-Polar Nephrometry: Integration and Optimization of R.E.N.A.L. and Centrality Index Scoring Systems. J Urol 2012; 188:384-90. [DOI: 10.1016/j.juro.2012.03.123] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Indexed: 01/20/2023]
Affiliation(s)
- Matthew N. Simmons
- Sections of Urologic Oncology and Minimally Invasive and Robotic Urologic Surgery, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Shahab P. Hillyer
- Sections of Urologic Oncology and Minimally Invasive and Robotic Urologic Surgery, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Byron H. Lee
- Sections of Urologic Oncology and Minimally Invasive and Robotic Urologic Surgery, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Amr F. Fergany
- Sections of Urologic Oncology and Minimally Invasive and Robotic Urologic Surgery, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jihad Kaouk
- Sections of Urologic Oncology and Minimally Invasive and Robotic Urologic Surgery, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Steven C. Campbell
- Sections of Urologic Oncology and Minimally Invasive and Robotic Urologic Surgery, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
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28
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Stroup SP, Palazzi K, Kopp RP, Mehrazin R, Santomauro M, Cohen SA, Patterson AL, L'Esperance JO, Derweesh IH. RENAL Nephrometry Score is Associated With Operative Approach for Partial Nephrectomy and Urine Leak. Urology 2012; 80:151-6. [DOI: 10.1016/j.urology.2012.04.026] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Revised: 04/12/2012] [Accepted: 04/13/2012] [Indexed: 01/20/2023]
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29
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