Predicting Strict Trifecta Outcomes after Robot-Assisted Partial Nephrectomy: Comparison of RENAL, PADUA, and C-Index Scores.

IF 1.9 Q3 ONCOLOGY Journal of Kidney Cancer and VHL Pub Date : 2021-10-01 eCollection Date: 2021-01-01 DOI:10.15586/jkcvhl.v8i4.183
Kaan Karamık, Yasin Aktaş, Ahmet Gürkan Erdemir, Ekrem İslamoğlu, Mahmut Taha Ölçücü, Çağatay Özsoy, Murat Savaş, Mutlu Ateş
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引用次数: 3

Abstract

Nephrometry scores are designed to characterize tumors and stratify the surgical complexity. It remains unclear as to which nephrometry score can accurately predict the surgical outcomes. We aimed to assess the utility of radius, exophytic/endophytic, nearness, anterior/posterior, location (RENAL), preoperative aspects and dimensions used for anatomic classifications (PADUA), and centrality index (C-index) nephrometry scores for predicting the strict Trifecta achievement from a single institution series robotic-assisted partial nephrectomy (RAPN). We retrospectively identified the prospectively maintained robotic surgery database records of 91 patients who underwent RAPN between June 2015 and September 2020 in Antalya Training and Research Hospital. The main outcome of the study was the achievement of strict Trifecta (negative surgical margin, no major urologic complications, warm ischemia time ≤25 min, and ≥85% preservation of estimated glomerular filtration rate). A multivariable analysis was performed to identify the factors of strict Trifecta success. The mean patient age was 55.82 ± 13.37 years with a median clinical tumor size of 3.5 cm (IQR 2.5-4.9). The median RENAL, PADUA, and C-index score were 7(IQR 6-8), 8(IQR 7-10), and 2.01(IQR 1.64-2.72), respectively. A strict Trifecta could be achieved in 54 patients (59.3%). Clinical tumor size (P = 0.011), RENAL risk groups (low:reference; intermediate; P = 0.040; high; P = 0.009), PADUA risk groups (low:reference; intermediate; P = 0.044; high; P = 0.001) and C-index risk groups (low:reference; high; P = 0.015) were the independent predictors of strict Trifecta attainment in the multivariate analysis. None of the nephrometry scores were a superior predictor compared to other nephrometry scores in comparative analysis. RENAL, PADUA, and C-index scores were all independent predictors of a strict Trifecta achievement. Our comprehensive comparison of the three scores identified that none of the nephrometry scores proved to be inferior to others nephrometry scores.

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预测机器人辅助部分肾切除术后严格的三联体预后:肾、PADUA和C-Index评分的比较。
肾测量评分是用来描述肿瘤特征和划分手术复杂性的。目前尚不清楚哪种肾测量评分能准确预测手术结果。我们的目的是评估半径、外生性/内生性、邻近性、前/后、位置(RENAL)、用于解剖分类的术前方面和尺寸(PADUA)以及中心性指数(C-index)肾脏测量评分在预测单一机构系列机器人辅助部分肾切除术(RAPN)的严格三合一成就方面的效用。我们回顾性地确定了2015年6月至2020年9月期间在安塔利亚培训和研究医院接受RAPN的91名患者的前瞻性机器人手术数据库记录。该研究的主要结果是达到严格的三联治疗(阴性手术切缘,无重大泌尿系统并发症,热缺血时间≤25分钟,估计肾小球滤过率≥85%)。进行了多变量分析,以确定严格三联疗法成功的因素。患者平均年龄55.82±13.37岁,中位临床肿瘤大小3.5 cm (IQR 2.5 ~ 4.9)。中位RENAL、PADUA和C-index评分分别为7(IQR 6-8)、8(IQR 7-10)和2.01(IQR 1.64-2.72)。54例患者(59.3%)能达到严格的三联曲治疗。临床肿瘤大小(P = 0.011)、肾危险组(低:参照;中间;P = 0.040;高;P = 0.009), PADUA危险组(低:参照;中间;P = 0.044;高;P = 0.001)和c指数危险组(低:参考;高;P = 0.015)是多变量分析中严格达到三联体的独立预测因子。在比较分析中,与其他肾测量评分相比,没有一个肾测量评分是更好的预测指标。RENAL、PADUA和C-index评分都是严格三合一评分的独立预测指标。我们对三个评分的综合比较发现,没有一个肾脏测量评分比其他肾脏测量评分差。
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审稿时长
4 weeks
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