First and second generation nephrometry scores for predicting peri- and post-operative results of kidney resection

Czech version

Authors: Petr Macek; Maria Stevens; Květoslav Novák; Michael Pešl; Tomáš Hanuš
Authors‘ workplace: Urologická klinika 1. LF UK a VFN v Praze
Published in: Ces Urol 2017; 21(2): 154-160
Category: Original Articles

Overview

Introduction:
Assessment of the first and the second generation nephrometric scores (NS) and their relationship with selected peri- and postoperative results of partial nephrectomies. We tested the correlation of NS with duration of warm ischemia (WI) and estimated glomerular filtration rate (eGF) change in per cent.

Patients and methods:
Prospective assessment of patients undergoing PN between 11/2015 and 6/2016. Tumor size, RENAL, PADUA, DAP scores and C-index as the first-generation NS and NePhRO, SARR a Tobert score as the second-generation NS were tested for correlation with duration of WI and per cent change of eGF.

Results:
We evaluated 35 patients, of which 21 had laparoscopic and 14 open PN. Median and interquartile ranges (IQR) were: age 65 (IQR 52–72), tumor size 35 mm (27–48), RENAL 8 (6–9), PADUA 9 (7–10), DAP 6 (5–7), C index 2.3 (1.6–2.6), NePhRO 9 (7–10), SARR 8 (7–11), Tobert score 7 (3–8), duration of WI 16 min (10–18), per cent change of eGF -5.3 % (-19.1 to -1.5). Duration of WI correlated significantly with tumor size and RENAL, PADUA, DAP, NePhRO, SARR, Tobert scores, and significantly, but inversely with C index. Correlation strength was mild to moderate. In contrast, per cent eGF change correlated significantly with RENAL, PADUA, DAP, NePhRO and SARR scores and tumor size, but not with C-index.

Conclusions:
WI correlated with tumor size and all NS used, but its strength was moderate at best. However, per cent change of eGF, did not correlated with C-index and Tobert score. This is in line with published data about estimated PN difficulty (with WI as surrogate marker), however our data and literature diverge in opinion on functional results. The difference might be due to small cohort size. The main impact of PN scoring systems is in the mutual comparison of PN data and gives us information we may use during counselling.

KEY WORDS:
Partial nephrectomy, nephrometric scores, warm ischemia, estimated glomerular filtration rate.

Sources

1. Znaor A, Lortet-Tieulent J, Laversanne M, Jemal A, Bray F. International variations and trends in renal cell carcinoma incidence and mortality. Eur Urol. 2015; 67(3): 519–530.

2. www.svod.cz, přístup 18. 2. 2017

3. Capitanio U, Montorsi F. Renal cancer. The Lancet 387(10021): 894–906.

4. Ljungberg B, Bensalah K, Canfield S, et al. EAU guidelines on renal cell carcinoma: 2014 update. Eur Urol. 2015; 67(5): 913–924.

5. Vigneswaran HT, Lec P, Brito J, et al. Partial nephrectomy for small renal masses: do teaching and nonteaching institutions adhere to guidelines equally? J Endourol. 2016; 30(6): 714–721.

6. Novák K. Laparoskopická resekce ledviny. Urol List. 2010; 8(1): 39–42.

7. Stránský P, Hora M, Hrbáček J, et al. Ischemie ledviny při resekcích ledvin a možnosti jejího ovlivnění. Ces Urol 2015; 19(2): 118–130.

8. Kutikov A, Uzzo RG. The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth. J Urol. 2009; 182(3): 844–853.

9. Ficarra V, Novara G, Secco S, et al. Preoperative aspects and dimensions used for an anatomical (PADUA) classification of renal tumours in patients who are candidates for nephron-sparing surgery. Eur Urol. 2009; 56(5): 786–793.

10. Simmons MN, Hillyer SP, Lee BH, et al. Diameter-axial-polar nephrometry: integration and optimization of R.E.N.A.L. and centrality index scoring systems. J Urol. 2012; 188(2): 384–390.

11. Simmons MN, Ching CB, Samplaski MK, Park CH, Gill IS. Kidney tumor location measurement using the C index method. J Urol. 2010; 183(5): 1708–1713.

12. Hakky TS, Baumgarten AS, Allen B, et al. Zonal NePhRO scoring system: a superior renal tumor complexity classification model. Clin Genitourin Cancer 2014; 12(1): e13–18.

13. Tannus M, Goldman SM, Andreoni C. Practical and intuitive surgical approach renal ranking to predict outcomes in the management of renal tumors: a novel score tool. J Endourol. 2014; 28(4): 487–492.

14. Tobert CM, Shoemaker A, Kahnoski RJ, Lane BR. Critical appraisal of first-generation renal tumor complexity scoring systems: Creation of a second-generation model of tumor complexity. Urol Oncol. 2015; 33(4): 167.e1–6.

15. Bjork J, Back SE, Sterner G, et al. Prediction of relative glomerular filtration rate in adults: new improved equations based on Swedish Caucasians and standardized plasma-creatinine assays. Scand J Clin Lab Inv. 2007; 67(7): 678–695.

16. Mukaka MM. Statistics corner: a guide to appropriate use of correlation coefficient in medical research. Malawi Med J. 2012; 24(3): 69–71.

17. Shin TY, Komninos C, Kim DW, et al. A novel mathematical model to predict the severity of postoperative functional reduction before partial nephrectomy: the importance of calculating resected and ischemic volume. J Urol. 2015; 193(2): 423–429.

18. Zhou L, Cao Y, Bian T, et al. Number of renal columns invaded by tumor: a novel parameter for predicting complexity and outcomes of off-clamp open partial nephrectomy. J Am Coll Surg. 2015; 221(2): 539–49.e1.

19. Leslie S, Gill IS, de Castro Abreu AL, et al. Renal tumor contact surface area: a novel parameter for predicting complexity and outcomes of partial nephrectomy. Eur Urol. 2014; 66(5): 884–893.

20. Tomaszewski JJ, Cung B, Smaldone MC, et al. Renal pelvic anatomy is associated with incidence, grade, and need for intervention for urine leak following partial nephrectomy. Eur Urol. 2014; 66(5): 949–955.

21. Roscigno M, Ceresoli F, Naspro R, et al. Predictive accuracy of nephrometric scores can be improved by adding clinical patient characteristics: a novel algorithm combining anatomic tumour complexity, body mass index, and Charlson comorbidity index to depict perioperative complications after nephron-sparing surgery. Eur Urol. 2014; 65(1): 259–262.

22. Minervini A, Vittori G, Salvi M, et al. Analysis of surgical complications of renal tumor enucleation with standardized instruments and external validation of PADUA classification. Ann Surg Oncol. 2013; 20(5): 1729–1736.

23. Kriegmair MC, Hetjens S, Mandel P, et al. Tumor size and invasiveness matters for partial nephrectomy: external validation and modification of the arterial based complexity score. J Surg Oncol. 2017; doi: 10.1002/jso.24565.

24. Borgmann H, Reiss AK, Kurosch M, et al. R.E.N.A.L. score outperforms PADUA score, C-Index and DAP score for outcome prediction of nephron sparing surgery in a selected cohort. J Urol. 2016; 196(3): 664–671.

25. Kriegmair MC, Mandel P, Moses A, et al. Defining renal masses: comprehensive comparison of RENAL, PADUA, NePhRO, and C-Index score. Clin Genitourin Cancer. 2016; pii: S1558–7673(16)30233–6.

26. Hou W, Yan W, Ji Z. Anatomic features involved in technical complexity of partial nephrectomy. Urol. 2015; 85(1): 1–7.

27. Kwon T, Jeong IG, Ryu J, et al. Renal function is associated with nephrometry score after partial nephrectomy: a study using Diethylene Triamine Penta-Acetic Acid (DTPA) renal scanning. Ann Surg Oncol. 2015; 22 Suppl 3: S1594–600.

28. Li M, Gao Y, Cheng J, et al. Diameter-axial-polar nephrometry is predictive of surgical outcomes following partial nephrectomy. Medicine. 2015; 94(30): e1228.