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Zhang X, Sun Q, Qi Y, Chen Y, Xiong Y, Xi W, Miao Z, Li X, Quan X, Lin J. Associations between R.E.N.A.L. nephrometry score and survival outcomes in renal tumours. Jpn J Clin Oncol 2024; 54:339-345. [PMID: 38117949 DOI: 10.1093/jjco/hyad174] [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] [Received: 09/29/2023] [Accepted: 11/29/2023] [Indexed: 12/22/2023] Open
Abstract
OBJECTIVE The radius-exophytic/endophytic-nearness-anterior/posterior-location nephrometry score could be used to predict surgical outcomes and renal tumour aggressiveness. We aimed to analyse its associations with survival outcomes. METHODS We included 1368 patients with sporadic, unilateral and non-metastatic renal tumours who received curative nephrectomy in Zhongshan Hospital from January 2009 to September 2019. Radius-exophytic/endophytic-nearness-anterior/posterior-location nephrometry scores were assigned by three urologists based on preoperative CT/MRI scans. Correlations between parameters or sum of radius-exophytic/endophytic-nearness-anterior/posterior-location nephrometry scores, overall survival and recurrence-free survival were analysed by Kaplan-Meier analyses and the multivariate Cox regression model. We further compared survival outcomes between patients who received partial nephrectomy and patients who received radical nephrectomy. RESULTS We observed statistically significant associations between all components of radius-exophytic/endophytic-nearness-anterior/posterior-location nephrometry scores and oncologic outcomes, including R (radius) (overall survival, P < 0.001; recurrence-free survival , P < 0.001), E (exophytic/endophytic) (overall survival, P = 0.003; recurrence-free survival, P < 0.001), N (nearness) (overall survival, P = 0.063; recurrence-free survival, P < 0.001), A (anterior/posterior) (overall survival, P < 0.001; recurrence-free survival, P = 0.005), L (location) (overall survival, P = 0.008; recurrence-free survival, P < 0.001) and suffix 'h' (overall survival, P = 0.237; recurrence-free survival, P = 0.034). Kaplan-Meier curves of overall survival and recurrence-free survival rates were significantly different when stratified by radius-exophytic/endophytic-nearness-anterior/posterior-location nephrometry score complexity group (overall survival, P < 0.001; recurrence-free survival, P < 0.001). After adjusting for tumour stage and grade, radius-exophytic/endophytic-nearness-anterior/posterior-location nephrometry score as continuous variables was an adverse independent risk factor for survival outcomes [P = 0.027, hazard ratio (95% confidence interval) = 1.151 (1.016-1.303)] and recurrence-free survival [P < 0.001, hazard ratio (95% confidence interval) = 1.299 (1.125-1.501)]. For tumours with radius-exophytic/endophytic-nearness-anterior/posterior-location nephrometry scores of 4 and 5, partial nephrectomy showed a survival benefit than radical nephrectomy. CONCLUSION Both components and complexity groups of the radius-exophytic/endophytic-nearness-anterior/posterior-location nephrometry score are associated with survival outcomes in renal tumour patients.
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Affiliation(s)
- Xue Zhang
- Department of Radiology, Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Qi Sun
- Department of Pathology, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, China
- Department of Pathology, Xiamen Clinical Research Center for Cancer Therapy, Xiamen, China
| | - Yangyang Qi
- Department of Immunology and Microbiology, Shanghai Jiao Tong University College of Basic Medical Sciences, Shanghai Institute of Immunology, Shanghai, China
| | - Yanyun Chen
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ying Xiong
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wei Xi
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhongchang Miao
- Department of Radiology, Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Xiaoxia Li
- Department of Radiology, Zhongshan Hospital(Xiamen), Fudan University, Xiamen, China
- Department of Radiology, Xiamen Clinical Research Center for Cancer Therapy, Xiamen, China
| | - Xiaoling Quan
- Department of Pathology, Hexi University Affiliated Zhangye People's Hospital, China
| | - Jinglai Lin
- Department of Urology, Zhongshan Hospital(Xiamen), Fudan University, Xiamen, China
- Department of Urology, Xiamen Clinical Research Center for Cancer Therapy, Xiamen, China
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Cerrato C, Meagher MF, Autorino R, Simone G, Yang B, Uzzo RG, Kutikov A, Porpiglia F, Capitanio U, Montorsi F, Porter J, Beksac AT, Puri D, Nguyen M, Wang L, Hakimi K, Dhanji S, Liu F, Cerruto MA, Pandolfo SD, Minervini A, Lau C, Monish A, Eun D, Mottrie A, Mir C, Sundaram C, Antonelli A, Kaouk J, Derweesh IH. Partial versus radical nephrectomy for complex renal mass: multicenter comparative analysis of functional outcomes (Rosula collaborative group). Minerva Urol Nephrol 2023; 75:425-433. [PMID: 37530659 DOI: 10.23736/s2724-6051.23.05123-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
BACKGROUND Utility of partial nephrectomy (PN) for complex renal mass (CRM) is controversial. We determined the impact of surgical modality on postoperative renal functional outcomes for CRM. METHODS We retrospectively analyzed a multicenter registry (ROSULA). CRM was defined as RENAL Score 10-12. The cohort was divided into PN and radical nephrectomy (RN) for analyses. Primary outcome was development of de-novo estimated glomerular filtration rate (eGFR)<45 mL/min/1.73 m2. Secondary outcomes were de-novo eGFR<60 and ΔeGFR between diagnosis and last follow-up. Cox proportional hazards was used to elucidate predictors for de-novo eGFR<60 and <45. Linear regression was utilized to analyze ΔeGFR. Kaplan-Meier Analysis (KMA) was performed to analyze 5-year freedom from de-novo eGFR<60 and <45. RESULTS We analyzed 969 patients (RN=429/PN=540; median follow-up 24.0 months). RN patients had lower BMI (P<0.001) and larger tumor size (P<0.001). Overall postoperative complication rate was higher for PN (P<0.001), but there was no difference in major complications (Clavien III-IV; P=0.702). MVA demonstrated age (HR=1.05, P<0.001), tumor-size (HR=1.05, P=0.046), RN (HR=2.57, P<0.001), and BMI (HR=1.04, P=0.001) to be associated with risk for de-novo eGFR<60 mL/min/1.73 m2. Age (HR=1.03, P<0.001), BMI (HR=1.06, P<0.001), baseline eGFR (HR=0.99, P=0.002), tumor size (HR=1.07, P=0.007) and RN (HR=2.39, P<0.001) were risk factors for de-novo eGFR<45 mL/min/1.73 m2. RN (B=-10.89, P<0.001) was associated with greater ΔeGFR. KMA revealed worse 5-year freedom from de-novo eGFR<60 (71% vs. 33%, P<0.001) and de-novo eGFR<45 (79% vs. 65%, P<0.001) for RN. CONCLUSIONS PN provides functional benefit in selected patients with CRM without significant increase in major complications compared to RN, and should be considered when technically feasible.
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Affiliation(s)
- Clara Cerrato
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA, USA
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
| | - Margaret F Meagher
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA, USA
| | | | - Giuseppe Simone
- Department of Urology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Bo Yang
- Department of Urology, Changhai Hospital, Shanghai, China
| | - Robert G Uzzo
- Division of Urology and Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Alexander Kutikov
- Division of Urology and Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Francesco Porpiglia
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Umberto Capitanio
- Division of Experimental Oncology, Unit of Urology, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Montorsi
- Division of Experimental Oncology, Unit of Urology, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Alp T Beksac
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Dhruv Puri
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA, USA
| | - Mimi Nguyen
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA, USA
| | - Luke Wang
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA, USA
| | - Kevin Hakimi
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA, USA
| | - Sohail Dhanji
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA, USA
| | - Franklin Liu
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA, USA
| | - Maria A Cerruto
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
| | | | | | - Clayton Lau
- Division of Urology and Urologic Oncology, City of Hope Medical Center, Duarte, CA, USA
| | - Aron Monish
- Institute of Urology, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Daniel Eun
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | | | - Carmen Mir
- Department of Urology, Hospital Universitario de la Ribera, Valencia, Spain
| | - Chandru Sundaram
- Department of Urology, Indiana University Health, Indianapolis, IN, USA
| | - Alessandro Antonelli
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
| | - Jihad Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ithaar H Derweesh
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA, USA -
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Abdel Aal AM, Nouh I, Azeem MA, Al Adl AM, Elmohamady BN. Prediction of surgical decision and postoperative renal function using RENAL nephrometry score for localized renal masses: A prospective study. Urol Ann 2023; 15:289-294. [PMID: 37664093 PMCID: PMC10471816 DOI: 10.4103/ua.ua_25_23] [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: 02/25/2023] [Revised: 04/04/2023] [Accepted: 04/11/2023] [Indexed: 09/05/2023] Open
Abstract
Purpose The purpose of the study is to assess the value of RENAL nephrometry score (RNS) in predicting surgical decisions, complications, and decreases in kidney function in patients with localized renal tumors. Methods Cases with solitary, solid, and enhancing renal masses were included, scheduled for nephron-sparing surgery (NSS), and assessed using routine laboratory and radiological data necessary for calculating the RENAL score. The primary endpoint was conversion to radical nephrectomy (RN), while the secondary endpoint was the prediction of a drop in renal function assessed by postoperative estimated glomerular filtration rate (eGFR) at the last follow-up visit compared with the preoperative values. The association between the scoring system and perioperative outcomes was evaluated. Results In all, 84 cases were included, NSS was accomplished in 67 cases while conversion to RN was mandatory in 17 patients, median (interquartile range) RENAL score was 6.2 (4-10) for NSS and 9.7 (6-12) for RN (P < 0.001). Higher grades of complications were observed in the high-complexity subgroup. eGFR was 79.8 that dropped to 75.6 ml/min/1.73 m2 in the late value in patients who underwent NSS, while it was 82.9 that dropped to 58.3 ml/min/1.73 m2 in the late value in patients who converted into RN (P < 0.001). The percentage of drop in eGFR was significantly higher in the moderate and high-risk groups, which was positively correlated with the warm ischemia time. Regression analysis revealed that the continuous RENAL score was a more significant predictor of conversion to RN than tumor size alone. In the 67 NNS cases, the percentage decrease in eGFR was predicted using the continuous RENAL score. Conclusion The RNS is a significant predictor of conversion to RN and can predict the percentage decrease in eGFR after NSS. Further investigations and follow-ups are necessary.
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Affiliation(s)
- Ashraf M. Abdel Aal
- Department of Urology, Benha Faculty of Medicine, Benha University, Benha, Egypt
| | - Islam Nouh
- Department of Urology, Benha Faculty of Medicine, Benha University, Benha, Egypt
| | - Mohamed Abdel Azeem
- Department of Urology, Benha Faculty of Medicine, Benha University, Benha, Egypt
| | - Ahmed M. Al Adl
- Department of Urology, Benha Faculty of Medicine, Benha University, Benha, Egypt
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Roussel E, Laenen A, Bhindi B, De Dobbeleer A, Stichele AV, Verbeke L, Van Cleynenbreugel B, Sprangers B, Beuselinck B, Van Poppel H, Joniau S, Albersen M. Predicting short- and long-term renal function following partial and radical nephrectomy. Urol Oncol 2023; 41:110.e1-110.e6. [PMID: 36372636 DOI: 10.1016/j.urolonc.2022.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/24/2022] [Accepted: 10/11/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To externally validate the previously published Mayo clinic model for the prediction of early (<30 days) postoperative renal failure, which relies solely on preoperative estimated glomerular filtration rate (eGFR) and develop a novel model for the prediction of long-term (>30 days) renal function after partial nephrectomy (PN) and radical nephrectomy (RN), including patient factors and nephrometry scores. PATIENTS AND METHODS Retrospective, single-center cohort study on patients who underwent PN or RN for a unilateral renal tumor between 2003 and 2019 with a preoperative eGFR of at least 15 ml/min/1.73m2. Early postoperative renal failure was defined as eGFR <15 ml/min/1.73 m2 or receipt of dialysis within 30 days. We determined the area under the receiver operating characteristics curve (AUC) to assess the Mayo clinic model's discriminative power. We used hierarchical linear mixed models with backward selection of candidate variables to develop a prediction model for long-term eGFR following PN and RN, separately. Their predictive ability was quantified using the marginal and conditional R2GLMM and an internal validation. RESULTS We included 421 patients (7,548 eGFR observations) who underwent PN and 271 patients (6,530 eGFR observations) who underwent RN. The Mayo clinic model for prediction of early postoperative renal failure following PN and RN showed an AUC of 0.816 (95% CI 0.718-0.920) and 0.825 (95% CI 0.688-0.962), respectively. In multivariable models, long-term eGFR following PN was associated with age, diabetes, the presence of a solitary kidney, tumor diameter and preoperative eGFR, while long-term eGFR following RN was associated with age, body mass index, RENAL nephrometry score and preoperative eGFR. Marginal and conditional R2GLMM were 0.591 and 0.855 for the PN model, and 0.363 and 0.849 for the RN model, respectively. CONCLUSIONS The Mayo clinic model for short-term renal failure prediction showed good accuracy on external validation. Our long-term eGFR prediction models depend mostly on host factors as opposed to tumor complexity and can aid in decision-making when considering PN vs. RN.
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Affiliation(s)
- Eduard Roussel
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Annouschka Laenen
- Institute for Biostatistics and Statistical Bioinformatics, Leuven, Belgium
| | - Bimal Bhindi
- Section of Urology, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | | | | | - Lien Verbeke
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | | | - Ben Sprangers
- Department of Microbiology, Immunology and Transplantation, Laboratory of Molecular Immunology (Rega Institute for Medical Research), KU Leuven, Leuven, Belgium; Department of Nephrology, University Hospitals Leuven, Leuven, Belgium
| | - Benoit Beuselinck
- Department of Nephrology, University Hospitals Leuven, Leuven, Belgium; Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium
| | | | - Steven Joniau
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Maarten Albersen
- Department of Urology, University Hospitals Leuven, Leuven, Belgium.
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Liu X, Xia D, Peng E, Tong Y, Liu H, Wang X, He Y, Chen Z, Tang K. Comparison of two techniques for the management of 2-3 cm lower pole renal calculi in obese patients. World J Urol 2021; 40:513-518. [PMID: 34766214 DOI: 10.1007/s00345-021-03872-6] [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: 06/29/2021] [Accepted: 10/26/2021] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE To compare the outcomes of mini percutaneous nephrolithotomy (mPNL) and retrograde intrarenal surgery (RIRS) for the management of 2-3 cm lower pole renal calculi (LPC) in obese patients. PATIENTS AND METHODS 120 obese patients with 2-3 cm LPC were randomly divided into mPNL group and RIRS group. Demography, clinical characteristics, perioperative complications, and stone free rate (SFR) were recorded. Stone-free status means no stone on computed tomography 3 months after surgery, or residual fragments were less than 3 mm. RESULTS Baseline characteristics were similar between the two groups. The mean stone burden was 585.39 ± 131.06 mm2 in the mPNL group and 548.64 ± 123.55 mm2 in the RIRS group (P = 0.125). The SFR of mPNL group was significantly better than that of RIRS group (86.2% vs 61.4%, P = 0.002). Besides, the overall complication rate was 22.4% in the mPNL group and 7% in the RIRS group (P = 0.02). Patients performed with mPNL required longer length of hospital stay than those with RIRS (P = 0.001). There were no significant differences in operative time and stone composition between the two groups. CONCLUSION In our study, both mPNL and RIRS are safe and effective techniques for the treatment of 2-3 cm LPC in obese patients. Compared to RIRS, mPNL has better SFR at the expense of the higher incidence of complications and prolonged length of hospital stay.
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Affiliation(s)
- Xiao Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Ding Xia
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Ejun Peng
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yonghua Tong
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Hailang Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Xinguang Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yu He
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Zhiqiang Chen
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
| | - Kun Tang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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Komeya M, Odaka H, Watanabe T, Kiuchi H, Ogawa T, Yao M, Matsuzaki J. Gap between UAS and ureteroscope predicts renal stone-free rate after flexible ureteroscopy with the fragmentation technique. World J Urol 2020; 39:2733-2739. [PMID: 32986134 DOI: 10.1007/s00345-020-03459-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 09/10/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To assess the effect of our new classification on surgical outcomes after flexible ureteroscopy (fURS) for kidney stones. METHODS We retrospectively examined 128 patients after single renal fURS procedures performed using ureteral access sheaths (UASs) with the fragmentation technique. Based on the gap (calculated by subtracting the ureteroscope diameter from the UAS diameter), enrolled patients were divided into three groups: small (< 0.6 mm), medium (0.6 to < 1.2 mm), and large space groups (≥ 1.2 mm). Stone-free (SF) status was defined as either complete absence of stones (SF) or the presence of stones < 4 mm in diameter on non-contrast computed tomography (NCCT). RESULTS The SF rate was significantly lower in the small space group (50% in small, 97.9% in medium, 89.2% in large; p = 0.001). Perioperative complications over Clavien-Dindo Grade I were observed in 16.7%, 4.2%, and 8.1% of patients, respectively (p = 0.452). The ratio of stone volume and operative time (efficiency of stone removal) was significantly higher in the large space group compared to the small and medium space groups (0.009 ± 0.003 ml/min, 0.013 ± 0.005 ml/min, 0.027 ± 0.012 ml/min, respectively; p < 0.001). CONCLUSION Our findings that gaps > 0.6 mm (1.8 Fr), including the combination of a 9.5-Fr UAS and a small caliber ureteroscope, improve SF rates, and larger gaps facilitate stone removal efficiency providing the basis for future development of clinical protocols aimed at improving outcomes.
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Affiliation(s)
- Mitsuru Komeya
- Department of Urology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan. .,Department of Urology, Yokohama City University Medical Center, 4-57 Urafune, Minami-ku, Yokohama, Kanagawa, 223-0024, Japan.
| | - Hisakazu Odaka
- Department of Urology, Ohguchi East General Hospital, 2-19-1 Irie, Kanagawa-ku, Yokohama, Kanagawa, 221-0014, Japan
| | - Takahiko Watanabe
- Department of Urology, Ohguchi East General Hospital, 2-19-1 Irie, Kanagawa-ku, Yokohama, Kanagawa, 221-0014, Japan
| | - Hirokazu Kiuchi
- Department of Urology, Ohguchi East General Hospital, 2-19-1 Irie, Kanagawa-ku, Yokohama, Kanagawa, 221-0014, Japan
| | - Takehiko Ogawa
- Department of Urology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Masahiro Yao
- Department of Urology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Junichi Matsuzaki
- Department of Urology, Ohguchi East General Hospital, 2-19-1 Irie, Kanagawa-ku, Yokohama, Kanagawa, 221-0014, Japan
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Ruan Y, Li D, Marshall H, Miao T, Cossetto T, Chan I, Daher O, Accorsi F, Goela A, Li S. MB-FSGAN: Joint segmentation and quantification of kidney tumor on CT by the multi-branch feature sharing generative adversarial network. Med Image Anal 2020; 64:101721. [PMID: 32554169 DOI: 10.1016/j.media.2020.101721] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 04/23/2020] [Accepted: 05/06/2020] [Indexed: 01/20/2023]
Abstract
The segmentation of the kidney tumor and the quantification of its tumor indices (i.e., the center point coordinates, diameter, circumference, and cross-sectional area of the tumor) are important steps in tumor therapy. These quantifies the tumor morphometrical details to monitor disease progression and accurately compare decisions regarding the kidney tumor treatment. However, manual segmentation and quantification is a challenging and time-consuming process in practice and exhibit a high degree of variability within and between operators. In this paper, MB-FSGAN (multi-branch feature sharing generative adversarial network) is proposed for simultaneous segmentation and quantification of kidney tumor on CT. MB-FSGAN consists of multi-scale feature extractor (MSFE), locator of the area of interest (LROI), and feature sharing generative adversarial network (FSGAN). MSFE makes strong semantic information on different scale feature maps, which is particularly effective in detecting small tumor targets. The LROI extracts the region of interest of the tumor, greatly reducing the time complexity of the network. FSGAN correctly segments and quantifies kidney tumors through joint learning and adversarial learning, which effectively exploited the commonalities and differences between the two related tasks. Experiments are performed on CT of 113 kidney tumor patients. For segmentation, MB-FSGAN achieves a pixel accuracy of 95.7%. For the quantification of five tumor indices, the R2 coefficient of tumor circumference is 0.9465. The results show that the network has reliable performance and shows its effectiveness and potential as a clinical tool.
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Affiliation(s)
- Yanan Ruan
- Shandong Key Laboratory of Medical Physics and Image Processing, Shandong Institute of Industrial Technology for Health Sciences and Precision Medicine, School of Physics and Electronics, Shandong Normal University, Jinan, Shandong 250358, China; University of Western Ontario, London ON, Canada
| | - Dengwang Li
- Shandong Key Laboratory of Medical Physics and Image Processing, Shandong Institute of Industrial Technology for Health Sciences and Precision Medicine, School of Physics and Electronics, Shandong Normal University, Jinan, Shandong 250358, China.
| | - Harry Marshall
- Department of Radiology, David Geffen School of Medicine at the University of California, Los Angeles, CA 90095, USA
| | - Timothy Miao
- Department of Medical Imaging, Western University Schulich School of Medicine and Dentistry, London ON, Canada
| | - Tyler Cossetto
- Department of Medical Imaging, Western University Schulich School of Medicine and Dentistry, London ON, Canada
| | - Ian Chan
- Department of Medical Imaging, Western University Schulich School of Medicine and Dentistry, London ON, Canada
| | - Omar Daher
- Department of Medical Imaging, Western University Schulich School of Medicine and Dentistry, London ON, Canada
| | - Fabio Accorsi
- Department of Medical Imaging, Western University Schulich School of Medicine and Dentistry, London ON, Canada
| | - Aashish Goela
- Department of Medical Imaging, Western University Schulich School of Medicine and Dentistry, London ON, Canada
| | - Shuo Li
- University of Western Ontario, London ON, Canada.
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Veccia A, Antonelli A, Uzzo RG, Novara G, Kutikov A, Ficarra V, Simeone C, Mirone V, Hampton LJ, Derweesh I, Porpiglia F, Autorino R. Predictive Value of Nephrometry Scores in Nephron-sparing Surgery: A Systematic Review and Meta-analysis. Eur Urol Focus 2019; 6:490-504. [PMID: 31776071 DOI: 10.1016/j.euf.2019.11.004] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 10/17/2019] [Accepted: 11/03/2019] [Indexed: 01/20/2023]
Abstract
CONTEXT Over the last decade, several nephrometry scores (NSs) have been introduced with the aim of facilitating preoperative decision making, planning, and counseling in the field of nephron-sparing surgery. However, their predictive role remains controversial. OBJECTIVE To describe currently available nephrometry scores and to determine their predictive role for different outcomes by performing a systematic review and meta-analysis of the literature. EVIDENCE ACQUISITION PubMed, Embase®, and Web of Science were screened to identify eligible studies. Identification and selection of the reports were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). A pooled analysis of NS predictive role of intraoperative, postoperative, oncological, and functional outcomes was performed. Odds ratio was considered the effect size. All the analyses were performed using Stata 15.0, and statistical significance was set at p≤ 0.05. EVIDENCE SYNTHESIS Overall, 51 studies meeting our inclusion criteria were identified and considered for the analysis. Except for one prospective randomized trial, all the studies were retrospective. All the studies were found to be of intermediate quality, except for one of high quality. Most studies assessed the predictive role of the Radius-Exophytic/Endophytic-Nearness-Anterior/Posterior-Location (RENAL) and Preoperative Aspects and Dimensions Used for an Anatomical (PADUA) scores, mostly regarding complications after nephron-sparing surgery. RENAL was an independent predictor of an on-clamp procedure (p< 0.001). Mayo Adhesive Probability score was related to adhesive perinephric fat (p= 0.005). Continuous and high-complexity RENAL scores were predictors of warm ischemia time (WIT; p= 0.006 and p< 0.001, respectively). Continuous (p< 0.001) and high-complexity (p< 0.001) PADUA scores were related to WIT. Continuous and high-complexity RENAL scores were predictors of overall complications (p= 0.002 and p< 0.001, respectively). PADUA score was related to complications both as continuous (p< 0.001) and as a categorical value (p< 0.002). The RENAL scores R=3 (p= 0.008), E=2 (p= 0.039), and hilar location (p= 0.006) were predictors of histological malignancy. Continuous and categorical RENAL scores were independent predictors of an estimated glomerular filtration rate (eGFR) increase (p= 0.006 and p< 0.001, respectively). The Diameter-Axial-Polar score (p= 0.018) and Peritumoral Artery Scoring System (PASS; p= 0.02) were also independent predictors. CONCLUSIONS The literature regarding nephrometry scoring systems is sparse, and mostly focused on RENAL and PADUA, which are easy to calculate and have a good correlation with most outcomes. Renal Pelvic Score is the best predictor of pelvicalyceal entry/repair and urine leak, whereas Surgical Approach Renal Ranking and PASS strongly predict surgical approach and renal function variation, respectively. Other nephrometry scores based on mathematical models are limited by their complexity, and they lack evidence supporting their predictive value. PATIENT SUMMARY We reviewed the medical literature regarding the use and value of so-called "nephrometry scores," which are scoring systems based on radiological imaging and made to grade the complexity of a renal tumor. We analyzed whether these scoring systems can predict some of the outcomes of patients undergoing surgical removal of renal tumors.
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Affiliation(s)
- Alessandro Veccia
- Division of Urology, VCU Health System, Richmond, VA, USA; Urology Unit, ASST Spedali Civili Hospital, Brescia, Italy and Department of Medical and Surgical Specialties, Radiological Science, and Public Health, University of Brescia, Italy
| | - Alessandro Antonelli
- Urology Unit, ASST Spedali Civili Hospital, Brescia, Italy and Department of Medical and Surgical Specialties, Radiological Science, and Public Health, University of Brescia, Italy
| | - Robert G Uzzo
- Division of Urology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Giacomo Novara
- Department of Oncologic, Surgical and Gastrointestinal Sciences, Urologic Unit, University of Padua, Italy
| | | | - Vincenzo Ficarra
- Department of Human and Pediatric Pathology "Gaetano Barresi", Urologic Section, University of Messina, Italy
| | - Claudio Simeone
- Urology Unit, ASST Spedali Civili Hospital, Brescia, Italy and Department of Medical and Surgical Specialties, Radiological Science, and Public Health, University of Brescia, Italy
| | - Vincenzo Mirone
- Department of Urology, Federico II University, Naples, Italy
| | | | - Ithaar Derweesh
- Department of Urology, UCSD Health System, La Jolla, CA, USA
| | - Francesco Porpiglia
- Division of Urology, San Luigi Hospital, University of Turin, Orbassano, Italy
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Rembeyo G, Correas JM, Jantzen R, Audenet F, Dariane C, Delavaud C, Mejean A, Timsit MO. Percutaneous Ablation Versus Robotic Partial Nephrectomy in the Treatment of cT1b Renal Tumors: Oncologic and Functional Outcomes of a Propensity Score-weighted Analysis. Clin Genitourin Cancer 2019; 18:138-147. [PMID: 31982346 DOI: 10.1016/j.clgc.2019.10.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 09/25/2019] [Accepted: 10/06/2019] [Indexed: 01/20/2023]
Abstract
INTRODUCTION The purpose of this study was to assess oncologic and functional outcomes of both percutaneous ablation (cryoablation and radiofrequency ablation) and robot-assisted partial nephrectomy (RAPN) in the treatment of renal tumors larger than 4 cm. MATERIALS AND METHODS We retrospectively analyzed prospectively collected data from 102 consecutive patients, who underwent minimally invasive treatment for cT1b renal tumors at our institution. Primary renal function outcome was assessed by estimated glomerular filtration rate preservation at baseline and 1 year postoperatively. Perioperative data and functional and oncologic outcome were collected. Multivariate regression models were used to compare functional outcomes between groups. Cancer-specific survival and recurrence-free survival were estimated at 2 years using the Kaplan-Meier method and compared with Cox proportional hazards regression model to calculate hazard ratios (HRs). To control for selection bias between the different treatments, we adjusted our models with an inverse probability of treatment weighting propensity score. RESULTS There was no significant difference in renal preservation between the groups (P = .664). Multivariate analysis did not show a statistically significant difference in terms of renal function outcomes between the RAPN and percutaneous thermal ablation groups. The adjusted HR regarding the local recurrence-free survival was significantly shorter for the cryoablation group (HR, 4.3; 95% confidence interval, 1.78-10.37; P = .001). CONCLUSIONS Our study demonstrated the equivalence between RAPN and percutaneous ablative techniques for the preservation of renal function in the treatment of T1b tumors. RAPN offers a better local control than percutaneous ablation, in terms of primary success rate.
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Affiliation(s)
- Gregory Rembeyo
- Department of Urology, HEGP, Paris, France; Université Paris Descartes, Faculté de Médecine, Paris, France.
| | - Jean-Michel Correas
- Université Paris Descartes, Faculté de Médecine, Paris, France; Department of Adult Radiology, Hôpital NECKER - Enfant Malades, Paris, France
| | - Rodolphe Jantzen
- Université Paris Descartes, Faculté de Médecine, Paris, France; Medical Informatics, Biostatistics and Public Health Department, HEGP, Paris, France
| | - François Audenet
- Department of Urology, HEGP, Paris, France; Université Paris Descartes, Faculté de Médecine, Paris, France
| | - Charles Dariane
- Department of Urology, HEGP, Paris, France; Université Paris Descartes, Faculté de Médecine, Paris, France
| | - Christophe Delavaud
- Université Paris Descartes, Faculté de Médecine, Paris, France; Department of Adult Radiology, Hôpital NECKER - Enfant Malades, Paris, France
| | - Arnaud Mejean
- Department of Urology, HEGP, Paris, France; Université Paris Descartes, Faculté de Médecine, Paris, France
| | - Marc-Olivier Timsit
- Department of Urology, HEGP, Paris, France; Université Paris Descartes, Faculté de Médecine, Paris, France
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10
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Vilaseca A, Guglielmetti G, Vertosick EA, Sjoberg DD, Grasso A, Benfante NE, Nguyen DP, Corradi RB, Coleman J, Russo P, Vickers AJ, Touijer KA. Value of Partial Nephrectomy for Renal Cortical Tumors of cT2 or Greater Stage: A Risk-benefit Analysis of Renal Function Preservation Versus Increased Postoperative Morbidity. Eur Urol Oncol 2019; 3:365-371. [PMID: 31411969 DOI: 10.1016/j.euo.2019.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 01/23/2019] [Accepted: 04/03/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND Indications for partial nephrectomy (PN) have expanded to include larger tumors. Compared with radical nephrectomy (RN), PN reduces the risk of chronic kidney disease but is associated with higher morbidity. OBJECTIVE To explore whether the benefit of PN (preservation of estimated glomerular filtration rate [eGFR] ≥60ml/min/1.73m2 1yr postoperatively) over RN is offset by higher morbidity for cT2-cT3a tumors. DESIGN, SETTING, AND PARTICIPANTS A total of 1921 patients with renal cortical tumors who underwent nephrectomy between 2000 and 2012 were analyzed, with 297 having clinical stage T2 or higher disease. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Multivariable logistic regression models adjusted for age, tumor size, and comorbidities were used to calculate the risk of complications within 90d and the risk of low eGFR across a range of tumor sizes. Models were created separately for RN and PN, and the difference between risk estimates was calculated. RESULTS AND LIMITATIONS For tumors with diameters between 7 and 12cm, the risk of eGFR downgrade associated with RN was higher than the risk of complications associated with PN. The magnitude of the risk of eGFR downgrade was similar to the magnitude of complications risk across all tumor sizes. Our analysis was performed at a single institution, and used only tumor size to compare the risk and benefits of surgery. CONCLUSIONS Our study suggests that PN is associated with higher eGFR preservation than RN for cT2 or greater renal tumors. The magnitude of this advantage offsets the higher morbidity observed with PN. PATIENT SUMMARY When treating a large kidney tumor, it is difficult to decide whether it is better to remove the whole kidney or remove just the tumor. The second option improves postoperative renal function but is more complex. We tried to find whether there is a tumor size at which one technique should be used over the other.
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Affiliation(s)
- Antoni Vilaseca
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Urology Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Giuliano Guglielmetti
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Emily A Vertosick
- Department of Epidemiology and Biostatistics, 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
| | - Angelica Grasso
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nicole E Benfante
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Daniel P Nguyen
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Renato B Corradi
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jonathan Coleman
- Urology Service, Department of Surgery, 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
| | - Andrew J Vickers
- Department of Epidemiology and Biostatistics, 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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11
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Kang SK, Huang WC, Elkin EB, Pandharipande PV, Braithwaite RS. Personalized Treatment for Small Renal Tumors: Decision Analysis of Competing Causes of Mortality. Radiology 2019; 290:732-743. [PMID: 30644815 PMCID: PMC6394736 DOI: 10.1148/radiol.2018181114] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 11/21/2018] [Accepted: 11/23/2018] [Indexed: 12/29/2022]
Abstract
Purpose To compare the effectiveness of personalized treatment for small (≤4 cm) renal tumors versus routine partial nephrectomy (PN), accounting for various competing causes of mortality. Materials and Methods A state-transition microsimulation model was constructed to compare life expectancy of management strategies for small renal tumors by using 1 000 000 simulations in the following ways: routine PN or personalized treatment involving percutaneous ablation for risk factors for worsening chronic kidney disease (CKD), and otherwise PN; biopsy, with triage of renal cell carcinoma (RCC) to PN or ablation depending on risk factors for worsening CKD; active surveillance for growth; and active surveillance when MRI findings are indicative of papillary RCC. Transition probabilities were incorporated from the literature. Effects of parameter variability were assessed in sensitivity analysis. Results In patients of all ages with normal renal function, routine PN yielded the longest life expectancy (eg, 0.67 years in 65-year-old men with nephrometry score [NS] of 4). Otherwise, personalized strategies extended life expectancy versus routine PN: in CKD stages 2 or 3a, moderate or high NS, and no comorbidities, MRI guidance for active surveillance extended life expectancy (eg, 2.60 years for MRI vs PN in CKD 3a, NS 10); and with Charlson comorbidity index of 1 or more, biopsy or active surveillance for growth extended life expectancy (eg, 2.70 years for surveillance for growth in CKD 3a, NS 10). CKD 3b was most effectively managed by using MRI to help predict papillary RCC for surveillance. Conclusion For patients with chronic kidney disease and small renal tumors, personalized treatment selection likely extends life expectancy. © RSNA, 2019 Online supplemental material is available for this article.
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Affiliation(s)
- Stella K. Kang
- From the Departments of Radiology (S.K.K.), Population Health (S.K.K., R.S.B.), Urology (W.C.H.), and Medicine (R.S.B.), NYU School of Medicine, 550 First Ave, New York, NY 10016; Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY (E.B.E.); and Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Boston, Mass (P.V.P.)
| | - William C. Huang
- From the Departments of Radiology (S.K.K.), Population Health (S.K.K., R.S.B.), Urology (W.C.H.), and Medicine (R.S.B.), NYU School of Medicine, 550 First Ave, New York, NY 10016; Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY (E.B.E.); and Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Boston, Mass (P.V.P.)
| | - Elena B. Elkin
- From the Departments of Radiology (S.K.K.), Population Health (S.K.K., R.S.B.), Urology (W.C.H.), and Medicine (R.S.B.), NYU School of Medicine, 550 First Ave, New York, NY 10016; Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY (E.B.E.); and Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Boston, Mass (P.V.P.)
| | - Pari V. Pandharipande
- From the Departments of Radiology (S.K.K.), Population Health (S.K.K., R.S.B.), Urology (W.C.H.), and Medicine (R.S.B.), NYU School of Medicine, 550 First Ave, New York, NY 10016; Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY (E.B.E.); and Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Boston, Mass (P.V.P.)
| | - R. Scott Braithwaite
- From the Departments of Radiology (S.K.K.), Population Health (S.K.K., R.S.B.), Urology (W.C.H.), and Medicine (R.S.B.), NYU School of Medicine, 550 First Ave, New York, NY 10016; Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY (E.B.E.); and Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Boston, Mass (P.V.P.)
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12
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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: 4] [Impact Index Per Article: 0.8] [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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13
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Abdel Raheem A, Shin TY, Chang KD, Santok GDR, Alenzi MJ, Yoon YE, Ham WS, Han WK, Choi YD, Rha KH. Yonsei nomogram: A predictive model of new-onset chronic kidney disease after on-clamp partial nephrectomy in patients with T1 renal tumors. Int J Urol 2018; 25:690-697. [PMID: 29923226 DOI: 10.1111/iju.13705] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 03/05/2018] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To develop a predictive nomogram for chronic kidney disease-free survival probability in the long term after partial nephrectomy. METHODS A retrospective analysis was carried out of 698 patients with T1 renal tumors undergoing partial nephrectomy at a tertiary academic institution. A multivariable Cox regression analysis was carried out based on parameters proven to have an impact on postoperative renal function. Patients with incomplete data, <12 months follow up and preoperative chronic kidney disease stage III or greater were excluded. The study end-points were to identify independent risk factors for new-onset chronic kidney disease development, as well as to construct a predictive model for chronic kidney disease-free survival probability after partial nephrectomy. RESULTS The median age was 52 years, median tumor size was 2.5 cm and mean warm ischemia time was 28 min. A total of 91 patients (13.1%) developed new-onset chronic kidney disease at a median follow up of 60 months. The chronic kidney disease-free survival rates at 1, 3, 5 and 10 year were 97.1%, 94.4%, 85.3% and 70.6%, respectively. On multivariable Cox regression analysis, age (1.041, P = 0.001), male sex (hazard ratio 1.653, P < 0.001), diabetes mellitus (hazard ratio 1.921, P = 0.046), tumor size (hazard ratio 1.331, P < 0.001) and preoperative estimated glomerular filtration rate (hazard ratio 0.937, P < 0.001) were independent predictors for new-onset chronic kidney disease. The C-index for chronic kidney disease-free survival was 0.853 (95% confidence interval 0.815-0.895). CONCLUSION We developed a novel nomogram for predicting the 5-year chronic kidney disease-free survival probability after on-clamp partial nephrectomy. This model might have an important role in partial nephrectomy decision-making and follow-up plan after surgery. External validation of our nomogram in a larger cohort of patients should be considered.
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Affiliation(s)
- Ali Abdel Raheem
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.,Department of Urology, Tanta University Medical School, Tanta, Egypt
| | - Tae Young Shin
- Department of Urology, Chuncheon Sacred Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - Ki Don Chang
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Glen Denmer R Santok
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Mohamed Jayed Alenzi
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.,Urology Department, Aljouf University, Sakakah, Saudi Arabia
| | - Young Eun Yoon
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Won Sik Ham
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Woong Kyu Han
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Young Deuk Choi
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Koon Ho Rha
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
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14
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External Validation of the Arterial-Based Complexity Score and First Head-to-Head Comparison With the R.E.N.A.L. and PADUA Scores and C-index. Clin Genitourin Cancer 2018; 16:e595-e604. [DOI: 10.1016/j.clgc.2017.10.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 10/19/2017] [Accepted: 10/30/2017] [Indexed: 12/29/2022]
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15
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Santok GD, Abdel Raheem A, Chang KD, Kim L, Lum TG, Alenzi MJ, Han WK, Choi YD, Rha KH. Estimated glomerular filtration rate's time to nadir after robot-assisted partial nephrectomy: Predictors and clinical significance on renal functional recovery. Int J Urol 2018; 25:660-667. [PMID: 29732637 DOI: 10.1111/iju.13589] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 03/05/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To investigate the impact of postoperative time to nadir of estimated glomerular filtration rate on renal functional changes after robot-assisted partial nephrectomy. METHODS From 2006 to 2015, 287 patients with renal mass who underwent robot-assisted partial nephrectomy in a referral center were analyzed. The cohort was evaluated based on their time to develop nadir: group 1 (no nadir), group 2 (<48 h) and group 3 (≥48 h). The outcome measures were to evaluate the renal function recovery between groups, risk factors for development of nadir ≥48 h, as well as predictors of chronic kidney disease upstaging. RESULTS The mean estimated glomerular filtration rate percentage change was the worst in group 3 compared with groups 1 and 2, with 13.8%, -0.67% and 8%, respectively (P < 0.001). Chronic kidney disease upstaging was more common in group 3 compared with the other groups (P < 0.001). Age, tumor size, PADUA score and warm ischemia time were predictors of developing ≥48 h estimated glomerular filtration rate nadir (odds ratio 1.04, P = 0.002; odds ratio 1.43, P < 0.001; odds ratio 1.24, P = 0.018; odds ratio 1.05, P < 0.001), respectively. The 5-year probability of freedom from chronic kidney disease upstaging was lower in group 3 (75.6%) compared with the other groups - 88.1% and 100% (P = 0.003). Time to nadir ≥48 h was a predictor of chronic kidney disease upstaging (odds ratio 3.02, P = 0.022). CONCLUSIONS A continuous decline in estimated glomerular filtration rate (≥48 h) after partial nephrectomy is associated with increased risk of poor functional recovery overtime. Age, tumor size, PADUA score and warm ischemia time are independent predictors of developing ≥48 h time to nadir of estimated glomerular filtration rate. This higher risk subgroup should be targeted for stricter follow up to allow early detection of future risk of renal functional decline.
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Affiliation(s)
- Glen Denmer Santok
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Ali Abdel Raheem
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.,Department of Urology, Tanta University Medical School, Tanta, Egypt
| | - Ki Don Chang
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Lawrence Kim
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Trenton G Lum
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Mohamed Jayed Alenzi
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.,Department of Urology, Aljouf University, Sakaka, Saudi Arabia
| | - Woong Kyu Han
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Young Deuk Choi
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Koon Ho Rha
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
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Hamilton ZA, Uzzo RG, Larcher A, Lane BR, Ristau B, Capitanio U, Ryan S, Dey S, Correa A, Reddy M, Proudfoot JA, Nasseri R, Yim K, Noyes S, Bindayi A, Montorsi F, Derweesh IH. Comparison of functional outcomes of robotic and open partial nephrectomy in patients with pre-existing chronic kidney disease: a multicenter study. World J Urol 2018. [DOI: 10.1007/s00345-018-2261-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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Arora HC, Fascelli M, Zhang JH, Isharwal S, Campbell SC. Kidney, Ureteral, and Bladder Cancer: A Primer for the Internist. Med Clin North Am 2018; 102:231-249. [PMID: 29406055 DOI: 10.1016/j.mcna.2017.10.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Malignancies of the urinary tract (kidney, ureter, and bladder) are distinct clinical entities. Hematuria is a unifying common presenting symptom for these malignancies. Surgical management of localized disease continues to be the mainstay of treatment, and early detection is important in the prognosis of disease. Patients often require life-long follow-up and assessment for recurrence.
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Affiliation(s)
- Hans C Arora
- Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue, Q10-1, Cleveland, OH 44195, USA
| | - Michele Fascelli
- Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue, Q10-1, Cleveland, OH 44195, USA
| | - Jj H Zhang
- Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue, Q10-1, Cleveland, OH 44195, USA
| | - Sudhir Isharwal
- Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue, Q10-1, Cleveland, OH 44195, USA
| | - Steven C Campbell
- Center for Urologic Oncology, Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue, Q10-1, Cleveland, OH 44195, USA.
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Comparison of retroperitoneal and transperitoneal robotic partial nephrectomy for Pentafecta perioperative and renal functional outcomes. World J Urol 2017; 35:1721-1728. [DOI: 10.1007/s00345-017-2062-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 06/09/2017] [Indexed: 01/09/2023] Open
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Gu L, Ma X, Li H, Yao Y, Xie Y, Chen L, Gao Y, Zhang X. External validation of the Arterial Based Complexity (ABC) scoring system in renal tumors treated by minimally invasive partial nephrectomy. J Surg Oncol 2017; 116:507-514. [PMID: 28570752 DOI: 10.1002/jso.24695] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 05/01/2017] [Indexed: 01/20/2023]
Affiliation(s)
- Liangyou Gu
- Department of Urology/State Key Laboratory of Kidney Diseases; Chinese PLA General Hospital/PLA Medical School; Beijing China
| | - Xin Ma
- Department of Urology/State Key Laboratory of Kidney Diseases; Chinese PLA General Hospital/PLA Medical School; Beijing China
| | - Hongzhao Li
- Department of Urology/State Key Laboratory of Kidney Diseases; Chinese PLA General Hospital/PLA Medical School; Beijing China
| | - Yuanxin Yao
- Department of Urology/State Key Laboratory of Kidney Diseases; Chinese PLA General Hospital/PLA Medical School; Beijing China
| | - Yongpeng Xie
- Department of Urology/State Key Laboratory of Kidney Diseases; Chinese PLA General Hospital/PLA Medical School; Beijing China
- School of Medicine; Nankai University; Tianjin China
| | - Luyao Chen
- Department of Urology/State Key Laboratory of Kidney Diseases; Chinese PLA General Hospital/PLA Medical School; Beijing China
| | - Yu Gao
- Department of Urology/State Key Laboratory of Kidney Diseases; Chinese PLA General Hospital/PLA Medical School; Beijing China
| | - Xu Zhang
- Department of Urology/State Key Laboratory of Kidney Diseases; Chinese PLA General Hospital/PLA Medical School; Beijing China
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Abstract
PURPOSE This AUA Guideline focuses on evaluation/counseling and management of adult patients with clinically localized renal masses suspicious for cancer, including solid-enhancing tumors and Bosniak 3/4 complex-cystic lesions. MATERIALS AND METHODS Systematic review utilized research from the Agency for Healthcare Research and Quality and additional supplementation by the authors and consultant methodologists. Evidence-based statements were based on body of evidence strength Grade A/B/C (Strong/Moderate/Conditional Recommendations, respectively) with additional statements presented as Clinical Principles or Expert Opinions. RESULTS Great progress has been made since the previous guidelines on management of localized renal masses were released (2009). The current guidelines provide updated, evidence-based recommendations regarding evaluation/counseling of patients with clinically localized renal masses, including the evolving role of renal mass biopsy. Given great variability of clinical, oncologic and functional characteristics, index patients are not utilized and the panel advocates individualized counseling/management. Management options (partial nephrectomy/radical nephrectomy/thermal ablation/active surveillance) are reviewed including recent data about comparative effectiveness and potential morbidities. Oncologic issues are prioritized while recognizing that functional outcomes are of great importance for survivorship for most patients with localized kidney cancer. A more restricted role for radical nephrectomy is recommended following well-defined selection criteria. Priority for partial nephrectomy is recommended for clinical T1a lesions, along with selective use of thermal ablation, particularly for tumors ≤3.0 cm. Important considerations for shared decision-making about active surveillance are explicitly defined. CONCLUSIONS Several factors should be considered during counseling/management of patients with clinically localized renal masses, including general health/comorbidities, oncologic potential of the mass, pertinent functional issues and relative efficacy/potential morbidities of various management strategies.
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Tumor Anatomy Scoring and Renal Function for Nephron-Sparing Treatment Selection in Patients With Small Renal Masses: A Microsimulation-Based Decision Analysis. AJR Am J Roentgenol 2016; 207:344-53. [DOI: 10.2214/ajr.15.15823] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Hsieh PF, Wang YD, Huang CP, Wu HC, Yang CR, Chen GH, Chang CH. A Mathematical Method to Calculate Tumor Contact Surface Area: An Effective Parameter to Predict Renal Function after Partial Nephrectomy. J Urol 2016; 196:33-40. [PMID: 26820552 DOI: 10.1016/j.juro.2016.01.092] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2016] [Indexed: 01/20/2023]
Affiliation(s)
- Po-Fan Hsieh
- Department of Urology, China Medical University Hospital, Taichung, Taiwan
| | - Yu-De Wang
- Department of Urology, China Medical University Hospital, Taichung, Taiwan
| | - Chi-Ping Huang
- Department of Urology, China Medical University Hospital, Taichung, Taiwan
| | - Hsi-Chin Wu
- School of Medicine, China Medical University, Taichung, Taiwan
- Department of Urology, An-Nan Hospital, Tainan, Taiwan
| | - Che-Rei Yang
- Department of Urology, China Medical University Hospital, Taichung, Taiwan
| | - Guang-Heng Chen
- Department of Urology, China Medical University Hospital, Taichung, Taiwan
| | - Chao-Hsiang Chang
- Department of Urology, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
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Reinstatler L, Klaassen Z, Barrett B, Terris MK, Moses KA. Body mass index and comorbidity are associated with postoperative renal function after nephrectomy. Int Braz J Urol 2016; 41:697-704. [PMID: 26401862 PMCID: PMC4756998 DOI: 10.1590/s1677-5538.ibju.2014.0383] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 10/23/2014] [Indexed: 01/20/2023] Open
Abstract
PURPOSE To explore the association of body mass index (BMI) and comorbidity with renal function after nephrectomy. MATERIALS AND METHODS We retrospectively analyzed 263 patients submitted to partial or radical nephrectomy from 2000-2013. Variables assessed included BMI, Charlson Comorbidity Index (CCI), race, tobacco use, tumor histology, surgical approach, Fuhrman nuclear grade, and tumor (T) classification. Glomerular filtration rate (GFR) was estimated using the Cockroft-Gault equation, adjusted for gender. Logistic regression was performed and included all interaction terms. RESULTS Median follow-up was 19.6 months (IQR 5.2, 53.7). Median preoperative GFR was 86.2 mL/min/1.73 m2 and median postoperative GFR was 68.4 mL/min/1.73 m2. BMI (OR 1.07, 95%CI 1.02-1.11), CCI (OR 1.19, 95%CI 1.04-1.37), and radical nephrectomy (OR 3.09, 95%CI 1.51-6.33) were significantly associated with a decline in renal function of ≥ 25%. CONCLUSION BMI and CCI are associated with postoperative decline in renal function after nephrectomy. Additionally, radical nephrectomy is significantly associated with decreasing renal function compared to partial nephrectomy. These findings highlight the importance of assessing patient comorbidity in the decision making process for patients presenting with a renal mass.
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Affiliation(s)
- Lael Reinstatler
- Department of Surgery, Section of Urology, Medical College of Georgia-Georgia Regents University, Augusta, GA
| | - Zachary Klaassen
- Department of Surgery, Section of Urology, Medical College of Georgia-Georgia Regents University, Augusta, GA
| | - Brittani Barrett
- Department of Surgery, Section of Urology, Medical College of Georgia-Georgia Regents University, Augusta, GA
| | - Martha K Terris
- Department of Surgery, Section of Urology, Medical College of Georgia-Georgia Regents University, Augusta, GA
| | - Kelvin A Moses
- Department of Surgery, Section of Urology, Medical College of Georgia-Georgia Regents University, Augusta, GA
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Percutaneous Renal Biopsies for Small Renal Masses: Complex Tumors on Nephrometry Should Be the First Targets. Clin Genitourin Cancer 2016; 14:e457-e462. [PMID: 27025355 DOI: 10.1016/j.clgc.2016.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 02/09/2016] [Accepted: 02/14/2016] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To assess the diagnostic yield, accuracy, and complications rate for computed tomography (CT)-guided renal biopsies for solid renal masses (SRM); to analyze predictive factors for diagnostic biopsies. PATIENTS AND METHODS We performed a single-center, retrospective study based on a pathologic database query for CT-guided, percutaneous renal biopsies. Inclusion criteria included presence of SRM; exclusion criteria included the presence of metastases, non-cT1a or higher cancer (> 4 cm), and non-CT-guided techniques. Of 119 patients who underwent renal biopsies, 40 (34%) were excluded from the study; 79 (66%) biopsy outcomes were analyzed. Clinical, radiologic (RENAL score), and pathologic features were reported. Differences between contributive and noncontributive biopsies were tested with Mann-Whitney U or chi-square tests, as appropriate. Multiple-variable analyses searching for predicting factors of biopsy contribution were performed with binary logistic regressions. RESULTS CT-guided renal biopsies for SRM present a high yield (88.6%) and high accuracy for differentiating malignant from benign tumors (96%). They are less accurate for histologic subtype (93%) and unreliable for Fuhrman grading (64%). CT-guided renal biopsy is safe (minor complication rate, 2.5%) and helped prevent unnecessary surgery in 30.4% of the cohort. Tumor complexity with high RENAL score was a predictive factor (P = .02) of contributive biopsy. CONCLUSION SRM biopsy is a safe, reliable procedure that can help determine the best treatment strategy for patients. It seems more beneficial for nephrometry complex tumors when surgical extirpation is more likely to be complicated. SRM biopsy might be encouraged in clinical practice for complex tumors.
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Kawamura N, Yokoyama M, Fujii Y, Ishioka J, Numao N, Matsuoka Y, Saito K, Arisawa C, Okuno T, Noro A, Morimoto S, Kihara K. Recovery of renal function after radical nephrectomy and risk factors for postoperative severe renal impairment: A Japanese multicenter longitudinal study. Int J Urol 2015; 23:219-23. [PMID: 26663437 DOI: 10.1111/iju.13028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 11/01/2015] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To investigate longitudinal changes in renal function after radical nephrectomy, and to explore risk factors of postoperative severe renal impairment in a Japanese multicenter cohort. METHODS The present retrospective study included 701 patients who had no metastasis, end-stage kidney disease or bilateral kidney cancer, who underwent radical nephrectomy and who were followed up for at least 1 year. The longitudinal change in postoperative renal function during a 10-year follow-up period was evaluated according to the presence or absence of potential risk factors including greater age, chronic kidney disease, hypertension, diabetes mellitus and cardiovascular disease. A slope of annual change in estimated glomerular filtration rate was analyzed using a linear mixed model. Associations between the potential risk factors and a >50% estimated glomerular filtration rate decrease were evaluated using a multivariate Cox regression model. RESULTS Overall, the postoperative estimated glomerular filtration rate recovered over time with a significant positive slope of 0.34 mL/min/1.73 m(2)/year. Renal function did not tend to recover in patients with chronic kidney disease, hypertension, diabetes mellitus or cardiovascular disease. The multivariate analysis showed that greater age and diabetes mellitus were independent risk factors for severe renal impairment. CONCLUSIONS Overall, patients who had deteriorated renal function immediately after radical nephrectomy recovered over time. However, patients with chronic kidney disease, hypertension, diabetes mellitus and cardiovascular disease did not tend to recover renal function postoperatively. Greater age and diabetes mellitus were independent risk factors for a >50% decrease in estimated glomerular filtration rate.
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Affiliation(s)
- Naoko Kawamura
- Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Minato Yokoyama
- Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Yasuhisa Fujii
- Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Junichiro Ishioka
- Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Noboru Numao
- Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Yoh Matsuoka
- Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Kazutaka Saito
- Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | | | - Tetsuo Okuno
- Department of Urology, JA Toride Medical Center, Toride, Japan
| | - Akira Noro
- Department of Urology, Saitama Red Cross Hospital, Saitama, Japan
| | - Shinji Morimoto
- Department of Urology, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Kazunori Kihara
- Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
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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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Analysis of Renal Functional Outcomes After Radical or Partial Nephrectomy for Renal Masses ≥7 cm Using the RENAL Score. Urology 2015; 86:312-9. [DOI: 10.1016/j.urology.2015.02.067] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Revised: 01/05/2015] [Accepted: 02/03/2015] [Indexed: 01/30/2023]
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Derweesh IH. Reply: To PMID 26189330. Urology 2015; 86:320. [PMID: 26189332 DOI: 10.1016/j.urology.2015.02.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
PURPOSE OF REVIEW To review current status of partial nephrectomy for treatment of T1b and T2 renal mass, focusing oncological and renal functional outcomes reported in the last 18 months, and to understand the emerging role of minimally invasive surgery (MIS) techniques in nephron-sparing management of T1b/T2 tumors. RECENT FINDINGS With recent long-term oncological equivalence to radical nephrectomy and renal functional benefit, partial nephrectomy is becoming an alternate standard to radical nephrectomy in the management of T1b tumors. The role of partial nephrectomy in nonelective treatment of T2 tumors is more controversial; however, recent publication of two large North American series have added to other contemporary work that suggests oncologic equivalence and renal functional benefit compared to radical nephrectomy in select patients. Emerging data demonstrate feasibility of MIS for increasing the proportion of T1b/T2 tumors; however, recent trends analyses demonstrate that the majority of T1b/T2 partial nephrectomy are still carried out by open surgery, and concerns continue about prolonged ischemic times and risk of bleeding in various MIS settings. SUMMARY Management of T1b and T2 renal masses is transforming with adoption of partial nephrectomy as a safe and feasible surgical option with comparable oncological and improved renal function outcomes compared to radical nephrectomy. MIS techniques play an expanding, though still limited, role, and more robust prospective data is requisite before drawing overarching conclusions.
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Kwon T, Jeong IG, Ryu J, Lee C, Lee C, You D, Kim CS. 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. [DOI: 10.1245/s10434-015-4500-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Indexed: 01/20/2023]
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Mobley JM, Kim EH, Larson JA, Figenshau RS, Vetter JM, Johnson MH, Bhayani SB. Patients with Pathologically Proven Renal Disease Have Similar Declines in Renal Function Following Robot-Assisted Partial Nephrectomy. J Endourol 2014; 28:1429-34. [DOI: 10.1089/end.2014.0228] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Jonathan M. Mobley
- Division of Urology, Washington University School of Medicine, St. Louis, Missouri
| | - Eric H. Kim
- Division of Urology, Washington University School of Medicine, St. Louis, Missouri
| | - Jeffrey A. Larson
- Division of Urology, Washington University School of Medicine, St. Louis, Missouri
| | - Robert S. Figenshau
- Division of Urology, Washington University School of Medicine, St. Louis, Missouri
| | - Joel M. Vetter
- Division of Urology, Washington University School of Medicine, St. Louis, Missouri
| | | | - Sam B. Bhayani
- Division of Urology, Washington University School of Medicine, St. Louis, Missouri
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Reddy UD, Pillai R, Parker RA, Weston J, Burgess NA, Ho ETS, Mills RD, Rochester MA. Prediction of complications after partial nephrectomy by RENAL nephrometry score. Ann R Coll Surg Engl 2014; 96:475-9. [PMID: 25198982 DOI: 10.1308/003588414x13946184903522] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION Discussing and planning the appropriate management for suspicious renal masses can be challenging. With the development of nephrometry scoring methods, we aimed to evaluate the ability of the RENAL nephrometry score to predict both the incidence of postoperative complications and the change in renal function after a partial nephrectomy. METHODS This was a retrospective study including 128 consecutive patients who underwent a partial nephrectomy (open and laparoscopic) for renal lesions in a tertiary UK referral centre. Univariate and multivariate ordinal regression models were used to identify associations between Clavien-Dindo classification and explanatory variables. The Kendall rank correlation coefficient was used to examine an association between RENAL nephrometry score and a drop in estimated glomerular filtration rate (eGFR) following surgery. RESULTS An increase in the RENAL nephrometry score of one point resulted in greater odds of being in a higher Clavien-Dindo classification after controlling for RENAL suffix and type of surgical procedure (odds ratio [OR]: 1.29, 95% confidence interval [CI]: 1.04-1.64, p=0.043). Furthermore, a patient with the RENAL suffix 'p' (ie posterior location of tumour) had increased odds of developing more serious complications (OR: 2.60, 95% CI: 1.07-6.30, p=0.042). A correlation was shown between RENAL nephrometry score and postoperative drop in eGFR (Kendall's tau coefficient -0.24, p=0.004). CONCLUSIONS To our knowledge, this is the first study that has shown the predictive ability of the RENAL nephrometry scoring system in a UK cohort both in terms of postoperative complications and change in renal function.
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Affiliation(s)
- U D Reddy
- Norfolk and Norwich University Hospitals NHS Foundation Trust, UK
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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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Mobley JM, Kim EH, Larson JA, Figenshau RS, Vetter JM, Johnson MH, Bhayani S. Patients with Pathologically Proven Renal Disease Have Similar Declines in Renal Function Following Robot-Assisted Partial Nephrectomy. J Endourol 2014. [DOI: 10.1089/end.2014-0228.ecc14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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