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四种肾肿瘤评分系统预测后腹腔镜下肾部分切除术临床结局的比较
作者:张浩洋  孙嘉乐  胡灿  周奇  欧阳骏  黄玉华  凌志新 
单位:苏州大学附属第一医院 泌尿外科, 江苏 苏州 215006
关键词:肾肿瘤评分 肾部分切除术 切缘 缺血 并发症 
分类号:R619;R699.2
出版年·卷·期(页码):2021·40·第四期(427-434)
摘要:

目的:比较R.E.N.A.L.、PADUA、C-index、DAP评分系统预测经后腹膜腹腔镜下肾部分切除术围手术期结局的效能。方法:回顾性分析我院131例接受后腹腔镜下肾部分切除术患者的临床资料,分别评估4种评分系统对术后达成MIC (即手术切缘阴性、热缺血时间<20 min、未出现Clavien-Dindo 3~4级的重大并发症)的预测效能。并进一步分析4种评分系统评分与其他围手术期结局的相关性。结果:4种评分系统均能够预测术后能否达成MIC,其中R.E.N.A.L.评分、DAP评分的预测效能最佳(P<0.001)。R.E.N.A.L.、DAP、C-index评分为低复杂的肿瘤患者更容易术后达成MIC (P<0.05)。4种评分系统评分均与手术时间及热缺血时间相关(P<0.05);C-index、DAP评分还与预计失血量相关(P<0.05)。结论:R.E.N.A.L.评分、DAP评分对肾肿瘤复杂程度评估及能否达到MIC结局预测效果最佳;4种评分与其他围手术期结局均具有不同程度的相关性。

Objective: To evaluate the efficacy of nephrometry scores R.E.N.A.L., PADUA, C-index and DAP in predicting perioperative outcome of retroperitoneal laparoscopic partial nephrectomy. Methods: The clinical data of 131 patients undergoing retroperitoneal laparoscopic partial nephrectomy in our hospital were retrospectively evaluated to determine the predictive value of each nephrometry score for MIC achievement. The MIC achievement was reached when surgical margins were negative, warm ischemia time was <20 min and no major complications(grade 3-4, according to Clavien-Dindo classification) occurred. Moreover, correlation was determined between the four nephrometry scoring systems scores and other quantitative perioperative outcomes. Results: All the four nephrometry scores were predictive for MIC achievement. Among them, the R.E.N.A.L. and DAP score had the best predictive value(P<0.001).MIC achievement rate was higher in tumors with low complexity compared to that with high complexity using nephrometry scores R.E.N.A.L., DAP and C-index(P<0.05). All the four nephrometry scores correlated with operative time and warm ischemia time(P<0.05). In addition, C-Index and DAP score also correlated with estimated blood loss(P<0.05). Conclusion: The R.E.N.A.L. and DAP scores correlate best with the complexity evaluation of renal tumors and MIC achievement. And all the four nephrometry scoring systems have varying degrees of correlation with other perioperative outcomes.

参考文献:

[1] BRAY F, FERLAY J, SOERJOMATARAM I, et al. Global cancer statistics 2018:GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2018, 68(6):394-424.
[2] 曹毛毛, 陈万青.中国恶性肿瘤流行情况及防控现状[J]. 中国肿瘤临床, 2019, 46(3):145-149.
[3] CAMPBELL S, UZZO R G, ALLAF M E, et al. Renal Mass and Localized Renal Cancer:AUA Guideline[J]. J Urol, 2017, 198(3):520-529.
[4] LJUNGBERG B, ALBIGES L, ABU-GHANEM Y, et al. European association of urology guidelines on renal cell carcinoma:the 2019 update[J]. Eur Urol, 2019, 75(5):799-810.
[5] TAKAGI T, YOSHIDA K, KONDO T, et al. Association between tumor contact surface area and parenchymal volume change in robot-assisted laparoscopic partial nephrectomy carried out using the enucleation technique[J]. Int J Urol, 2019, 26(7):745-751.
[6] BYLUND J R, GAYHEART D, FLEMING T, et al. Association of tumor size, location, R.E.N.A.L., PADUA and centrality index score with perioperative outcomes and postoperative renal function[J]. J Urol, 2012, 188(5):1684-1689.
[7] KUTIKOV A, UZZO R G.The R.E.N.A.L.nephrometry score:a comprehensive standardized system for quantitating renal tumor size, location and depth[J]. J Urol, 2009, 182(3):844-853.
[8] FICARRA V, NOVARA G, SECCO S, et al. Preoperative aspects and dimensions used for an anatomical(PADUA) classification of renal tumours in patients who are candidates for nephron-sparing surgery[J]. Eur Urol, 2009, 56(5):786-793.
[9] SIMMONS M N, CHING C B, SAMPLASKI M K, et al. Kidney tumor location measurement using the C index method[J]. J Urol, 2010, 183(5):1708-1713.
[10] SIMMONS M N, HILLYER S P, LEE B H, et al. Diameter-axial-polar nephrometry:integration and optimization of R.E.N.A.L.and centrality index scoring systems[J]. J Urol, 2012, 188(2):384-390.
[11] YOON Y E, CHOI K H, LEE K S, et al. Usefulness of the diameter-axial-polar nephrometry score for predicting perioperative parameters in robotic partial nephrectomy[J]. World J Urol, 2015, 33(6):841-845.
[12] NAGAHARA A, UEMURA M, KAWASHIMA A, et al. R.E.N.A.L.nephrometry score predicts postoperative recurrence of localized renal cell carcinoma treated by radical nephrectomy[J]. Int J Clin Oncol, 2016, 21(2):367-372.
[13] HSIEH P F, WANG Y D, HUANG C P, et al. A mathematical method to calculate tumor contact surface area:an effective parameter to predict renal function after partial nephrectomy[J]. J Urol, 2016, 196(1):33-40.
[14] BUFFI N, LISTA G, LARCHER A, et al. Margin, ischemia, and complications (MIC) score in partial nephrectomy:a new system for evaluating achievement of optimal outcomes in nephron-sparing surgery[J]. Eur Urol, 2012, 62(4):617-618.
[15] SHI N, ZU F, SHAN Y, et al. The value of renal score in both determining surgical strategies and predicting complications for renal cell carcinoma:a systematic review and meta-analysis[J]. Cancer Med, 2020, 9(11):3944-3953.
[16] WANG H K, QIN X J, MA C G, et al. Nephrometry score-guided off-clamp laparoscopic partial nephrectomy:patient selection and short-time functional results[J]. World J Surg Oncol, 2016, 14(1):163.
[17] CERANTOLA Y, PLOUSSARD G, KASSOUF W, et al. Does teaching of robotic partial nephrectomy affect renal function and perioperative outcomes?[J]. Urol Oncol, 2017, 35(5):227-233.
[18] SCHIAVINA R, NOVARA G, BORGHESI M, et al. PADUA and R.E.N.A.L.nephrometry scores correlate with perioperative outcomes of robot-assisted partial nephrectomy:analysis of the Vattikuti Global Quality Initiative in Robotic Urologic Surgery(GQI-RUS) database[J]. BJU Int, 2017, 119(3):456-463.
[19] LI M, GAO Y, CHENG J, et al. Diameter-Axial-Polar nephrometry is predictive of surgical outcomes following partial nephrectomy[J]. Medicine (Baltimore), 2015, 94(30):e1228.
[20] WANG Y D, HUANG C P, CHANG C H, et al. The role of RENAL, PADUA, C-index, CSA nephrometry systems in predicting ipsilateral renal function after partial nephrectomy[J]. BMC Urol, 2019, 19(1):72.
[21] KRIEGMAIR M C, MANDEL P, MOSES A, et al. Defining renal masses:comprehensive comparison of RENAL, PADUA, NePhRO, and C-Index score[J]. Clin Genitourin Cancer, 2017, 15(2):248-255.
[22] LISTA G, BUFFI N M, LUGHEZZANI G, et al. Margin, ischemia, and complications system to report perioperative outcomes of robotic partial nephrectomy:a European Multicenter Observational Study(EMOS project)[J]. Urology, 2015, 85(3):589-595.
[23] UBRIG B, ROOSEN A, WAGNER C, et al. Tumor complexity and the impact on MIC and trifecta in robot-assisted partial nephrectomy:a multi-center study of over 500 cases[J]. World J Urol, 2018, 36(5):783-788.
[24] XIE Y, MA X, GU L, et al. Associating the learning curve and tumor anatomical complexity with the margins, ischemia, and complications rate after robot-assisted partial nephrectomy[J]. Int J Surg, 2016, 36(Pt A):219-224.
[25] BORGMANN H, REISS A K, KUROSCH M, et al. R.E.N.A.L.score outperforms PADUA score, C-Index and DAP score for outcome prediction of nephron sparing surgery in a selected cohort[J]. J Urol, 2016, 196(3):664-671.

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