Comparison of Three Nephrometry Scoring Systems in Predicting the Patient Outcomes Following Partial or Radical Nephrectomy
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Abstract
Background: Multiple nephrometry scoring systems are developed to evaluate anatomical characteristics of renal mass and help the preoperative decision making for partial nephrectomy. However, there are limited data on the comparison among these scoring systems in predicting perioperative and postoperative outcomes after surgical treatment of renal mass.
Objective: To compare the correlation of three nephrometry scoring systems with perioperative and postoperative outcomes following surgical treatment of renal mass.
Materials and Methods: We conducted a retrospective analysis including the patients with renal mass (diameter < 7 cm) who underwent partial nephrectomy or radical nephrectomy. Three nephrometry scores were evaluated in each patient, including centrality-index (C›Index), preoperative aspects and dimensions used for anatomic (PADUA) score, and radius, exophyic/endophytic, nearness, anterior/posterior, and location (R.E.N.A.L.) nephrometry scores. We evaluated the differences between the partial and radical nephrectomy groups in terms of these three mean scoring systems and analyzed the correlation with postoperative outcomes.
Results: A total of 83 patients were included. There were significant differences in the mean scores of these three systems between partial and radical nephrectomy groups (6.5 vs 8.6, P < 0.001 in R.E.N.A.L nephrometry
score, 7.3 vs 8.7, P < 0.001 in PADUA score, and 2.2 vs 1.3, P < 0.005 in C-Index). With regard to the outcome of the partial nephrectomy, R.E.N.A.L. nephrometry score was significantly associated with the warm ischemia time (WIT) and percentage change in estimated glomerular filtration rate (eGFR) (P = 0.001). PADUA score was significantly associated with WIT (P = 0.039), whereas C-Index was significantly associated with percentage change in eGFR (P = 0.011). There was no significant correlation among all three scoring systems with operative time, postoperative complications and estimated blood loss.
Conclusion: All three nephrometry scores were found to be the useful tools aiding the surgeon decision between partial and radical nephrectomy. R.E.N.A.L. nephrometry score had more benefit over C-index and PADUA score in the aspect of correlation with WIT and percentage change in postoperative eGFR in the patients who underwent partial nephrectomy. However, further large-scale prospective studies are needed to confirm our results.
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References
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