Nephrometry Scoring System Research Articles

Predicting post-surgical complications using renal scoring systems.

Current surgical approaches for renal malignancies primarily rely on qualitative factors such as patient preferences, surgeon experience, and hospital capabilities. Applying a quantitative method for consistent and reliable assessment of renal lesions would significantly enhance surgical decision-making and facilitate data comparison. Nephrometry scoring (NS) systems systematically evaluate and describe renal tumors based on their anatomical features. These scoring systems, including R.E.N.A.L., PADUA, MAP scores, C-index, CSA, and T-index, aim to predict surgical complications by evaluating anatomical and patient-specific factors. In this review paper, we explore the components and methodologies of these scoring systems, compare their effectiveness and limitations, and discuss their application in advancing patient care and optimizing surgical outcomes.

Construction and application of a three-dimensional vascular variation-based nephrometry scoring system for completely endophytic renal tumors

BackgroundCompletely endophytic renal tumors (CERT) pose significant challenges due to their anatomical complexity and loss of visual clues about tumor location. A facile scoring model based on three-dimensional (3D) reconstructed images will assist in better assessing tumor location and vascular variations. MethodsIn this retrospective study, 80 patients diagnosed with CERT were included. Forty cases underwent preoperative assessment using 3D reconstructed imaging (3D-Cohort), while the remaining 40 cases were assessed using two-dimensional imaging (2D-Cohort). Vascular variations were evaluated by ascertaining the presence of renal arteries > 1, prehilar branching arteries, and arteries anterior to veins. The proposed scoring system, termed RAL, encompassed three critical components: (R)adius (maximal tumor diameter in cm), (A)rtery (occurrence of arterial variations), and (L)ocation relative to the polar line. Comparison of the RAL scoring system was made with established nephrometry scoring systems. ResultsA total of 48 (60 %) patients exhibited at least one vascular variation. In the 2D-Cohort, patients with vascular variations experienced significantly prolonged operation time, increased bleeding volume, and extended warm ischemia time compared with those without vascular variations. Conversely, the presence of vascular variations did not significantly affect operative parameters in the 3D-Cohort. Furthermore, the 2D-Cohort demonstrated a notable decline in both short- and long-term estimated glomerular filtration rate (eGFR) changes compared with the 3D-Cohort, a trend consistent across patients with warm ischemia time ≥ 25 min and those with vascular variations. Notably, the 2D-Cohort exhibited a larger margin of normal renal tissue compared with the 3D-Cohort. Elevated RAL scores correlated with larger tumor size, prolonged operation time, extended warm ischemia time, and substantial postoperative eGFR decrease. The RAL scoring system displayed superior predictive capabilities in assessing postoperative eGFR changes compared with conventional nephrometry scoring systems. ConclusionsOur proposed 3D vascular variation-based nephrometry scoring system offers heightened proficiency in preoperative assessment, precise prediction of surgical complexity, and more accurate evaluation of postoperative renal function in CERT patients.

Nephrometry Scoring Systems for Nephron Sparing Surgery in Children.

The surgical decision to attempt nephron-sparing surgery (NSS) in children with renal tumors can be difficult. In adults, nephrometric tools are used for decision-making. More than 90% of low-complexity tumors are eligible for NSS, and high-complexity tumors often require total nephrectomy. We retrospectively applied those nephrometric tools [Radius, Exophytic, Nearness to the sinus or collecting system, Anterior/posterior, Location relative to polar lines (RENAL), Preoperative Aspects and Dimensions Used for an Anatomical classification (PADUA), and Renal Tumor Invasion Index (RTII) scoring systems] to the preoperative imaging of children operated for renal tumors in our institution from 2015 to 2019 and correlated them with the type of surgery. The scores were assessed by 2 independent surgeons and 1 radiologist. Forty-four tumors were removed, including 16 NSS, 38 after neo-adjuvant chemotherapy, and 6 upfront surgeries, in 30 children. More than 50% of patients in the low and medium-risk population for RENAL, PADUA, and RTII scores, and ~15% in the high-complexity categories underwent NSS. Tumors removed through NSS were significantly less complex according to each score. Interobserver reliability was good for 3 scores. The application of the RENAL, PADUA, and RTII was able to accurately classify most of the pediatric tumors, according to their complexity. These scores could help increase the indications of NSS in renal tumor surgery.

Can Simplified PADUA Renal (SPARE) Nephrometry scoring system help predict renal function outcomes after robot-assisted partial nephrectomy? (UroCCR study 93).

The SPARE Nephrometry Score (NS) is described as easier to implement than the RENAL and PADUA NSs, currently more widely used. Our objective was to compare the accuracy of SPARE NS in predicting renal function outcomes following RAPN. A multicentric retrospective study was conducted using French kidney cancer network (UroCCR, NCT03293563) database. All patients included had RAPN for cT1 renal tumors between May 2010 and March 2021. SPARE was compared to RENAL, PADUA and Tumor Size to predict postoperative acute kidney injury (AKI), chronic kidney disease (CKD) upstaging, de novo CKD at 3-6 months follow-up and Trifecta failure. The ability of the different NSs and tumor size to predict renal function outcomes was evaluated using uni- and multivariate logistic regression models. According to our study criteria, 1171 patients were included. Mean preoperative tumor size and estimated glomerular filtration rate (eGFR) were 3.4±1.4 cm and 85.8 mL/min/1.73 m2. In total, 266 (22.7%), 87 (7.4%), 94 (8%), and 624 (53.3%) patients had AKI, de novo CKD, CKD upstaging, and Trifecta failure, respectively. In multivariate analysis, all three NSs and tumor size were independent predictors of AKI, CKD de novo, CKD upgrade and Trifecta failure. There was no significant difference between all three NS and tumor sizes in predicting renal function outcomes. SPARE Score seems to be a valid alternative to predict renal function outcomes after RAPN. Nevertheless, in our study, tumor size was as accurate as NSs in predicting postoperative outcomes and, therefore, seems to be the logical choice for surgical decisions.

Utilizing the R.E.N.A.L Nephrometry Score to predict the Surgical Technique and Peri-operative Outcomes of Renal Masses

Background: despite the rise in the incidence of renal cell carcinoma attributed to availability of medical imaging, a considerable decline in mortality is an association. Morbidity-wise, the shift from radical nephrectomy to partial nephrectomy is the trend for now. Multiple scoring systems have been introduced over the past decades to help surgeons choose between radical and partial nephrectomy. One commonly used system is the RENAL nephrometry score that was first introduced by Kutikov and Uzzo in 2009. Objective: to evaluate the role of RENAL nephrometry scoring system in predicting the surgical technique to use to resect renal masses and associated perioperative outcomes. Subjects and methods: between December 2018 and December 2020, we prospectively recruited 88 patients with renal masses. Nephrometry scores of all patients were calculated by an experienced radiologist and a decision then was made by blinded treating surgeons to proceed to radical or partial nephrectomy. Patients then sub-grouped into low, moderate, and high nephrometry scores, and into radical and partial nephrectomy. Pre-, intra-, and post-operative data were collected and analyzed. Results: Eighty-three patients completed the study. Thirty-three had undergone radical nephrectomy and 50 had partial nephrectomy. Total nephrometry score differed significantly between the two groups. Mass radius and nearness to the renal hilum were the only influential components. The only complication that differed significantly among the three nephrometry groups was the estimated blood loss, being highest in the low complexity group. No significant difference was found in the total operation time, ischemia time, renal function and hospital stay. Major complications were seen only in the high complexity group. Conclusion: Total nephrometry score, mass radius and nearness to renal hilum can be regarded as good and reproducible predictors of type of surgery required to treat renal masses. They also can predict the perioperative complication to a good extent.

RENAL nephrometry scoring system in bilateral Wilms tumor: predictive application

RENAL nephrometry scoring system in bilateral Wilms tumor: predictive application

RPN (Radius, Position of tumour, iNvasion of renal sinus) Classification and Nephrometry Scoring System: An Internationally Developed Clinical Classification To Describe the Surgical Difficulty for Renal Masses for Which Robotic Partial Nephrectomy Is Planned

BackgroundThe surgical difficulty of partial nephrectomy (PN) varies depending on the operative approach. Existing nephrometry classifications for assessment of surgical difficulty are not specific to the robotic approach. ObjectiveTo develop an international robotic-specific classification of renal masses for preoperative assessment of surgical difficulty of robotic PN. Design, setting, and participantsThe RPN classification (Radius, Position of tumour, iNvasion of renal sinus) considers three parameters: tumour size, tumour position, and invasion of the renal sinus. In an international survey, 45 experienced robotic surgeons independently reviewed de-identified computed tomography images of 144 patients with renal tumours to assess surgical difficulty of robot-assisted PN using a 10-point Likert scale. A separate data set of 248 patients was used for external validation. Outcome measurements and statistical analysisMultiple linear regression was conducted and a risk score was developed after rounding the regression coefficients. The RPN classification was correlated with the surgical difficulty score derived from the international survey. External validation was performed using a retrospective cohort of 248 patients. RPN classification was also compared with the RENAL (Radius; Exophytic/endophytic; Nearness; Anterior/posterior; Location), PADUA (Preoperative Aspects and Dimensions Used for Anatomic), and SPARE (Simplified PADUA REnal) scoring systems. Results and limitationThe median tumour size was 38 mm (interquartile range 27–49). The majority (81%) of renal tumours were peripheral, followed by hilar (12%) and central (7.6%) locations. Noninvasive and semi-invasive tumours accounted for 37% each, and 26% of the tumours were invasive. The mean surgical difficulty score was 5.2 (standard deviation 1.9). Linear regression analysis indicated that the RPN classification correlated very well with the surgical difficulty score (R2 = 0.80). The R2 values for the other scoring systems were: 0.66 for RENAL, 0.75 for PADUA, and 0.70 for SPARE. In an external validation cohort, the performance of all four classification systems in predicting perioperative outcomes was similar, with low R2 values. ConclusionsThe proposed RPN classification is the first nephrometry system to assess the surgical difficulty of renal masses for which robot-assisted PN is planned, and is a useful tool to assist in surgical planning, training and data reporting. Patient summaryWe describe a simple classification system to help urologists in preoperative assessment of the difficulty of robotic surgery for partial kidney removal for kidney tumours.

Single-port vs multi-port robot-assisted renal surgery: analysis of perioperative outcomes for excision of high and low complexity renal masses.

There is emerging but limited data assessing single-port (SP) robot-assisted surgery as an alternative to multi-port (MP) platforms. We compared perioperative outcomes between SP and MP robot-assisted approaches for excision of high and low complexity renal masses. Retrospective chart review was performed for patients undergoing robot-assisted partial or radical nephrectomy using the SP surgical system (n = 23) at our institution between November 2019 and November 2021. Renal masses were categorized as high complexity (7+) or low complexity (4-6) using the R.E.N.A.L. nephrometry scoring system. Adjusting for baseline characteristics, patients were matched using a prospectively maintained MP database in a 2:1 (MP:SP) ratio. For high complexity tumors (n = 12), SP surgery was associated with a significantly longer operative time compared to MP (248.4 vs 188.1min, p = 0.02) but a significantly shorter length of stay (1.9 vs 2.8days, p = 0.02). For low complexity tumors (n = 11), operative time (177.7 vs 161.4min, p = 0.53), estimated blood loss (69.6.0 vs 142.0mL, p = 0.62), and length of stay (1.6 vs 1.8days, p = 0.528) were comparable between SP and MP approaches. Increasing nephrometry score was associated with a greater relative increase in operative time for SP compared to MP renal surgery (p = 0.07) using best of fit linear modeling. SP robot-assisted partial and radical nephrectomy is safe and feasible for low complexity renal masses. For high complexity renal masses, the SP system is associated with a significantly longer operative time compared to the MP technique. Careful consideration should be given when selecting patients for SP robot-assisted kidney surgery.

Search for the optimized and key nephrometry elements combination in retroperitoneal laparoscopic partial nephrectomy: A retrospective study.

The nephrometry scoring system plays a key role in the preoperative evaluation of partial nephrectomy, and scoring systems based on anatomical characteristics have high similarity in scoring elements. Currently, there is little research on scoring systems related to retroperitoneal laparoscopic partial nephrectomy, and there is a lack of research on the combination of scoring elements, which requires further investigation. We retrospectively analyzed the clinical records of 107 patients who underwent retroperitoneal laparoscopic partial nephrectomy conducted by a single operator at a single center. The score and scoring elements were generated based on imaging. The scoring elements of each scoring system and all combinations of two to five elements were extracted. The predictive ability of different score combinations was evaluated by AUC value, and the key parameters of the score were found by taking the intersection. A nomogram was constructed and evaluated. We observed that with an increase in scoring elements, the strongest combination of elements did not significantly increase the predictive ability of warm ischemia time (P>0.05), postoperative complications (P>0.05), and trifecta achievement (P>0.05). The combination of the maximum tumor diameter and the distance between tumor and collecting system or renal sinus had a good comprehensive predictive ability, and there is no significant difference with the traditional score (P>0.05). The nomogram generated according to this combination has an excellent prediction ability for predicting whether obtain trifecta of partial nephrectomy. Within the range of two to five elements, the critical degree of elements is more important than the number of elements. The maximum tumor diameter and the distance between the tumor and the collecting system or renal sinus was the key element of the prediction ability.

Predictive accuracy of computer-generated C-index nephrometry scores compared with human-generated scores in predicting oncologic and perioperative outcomes.

623 Background: The Centrality index (C-index) score is a validated nephrometry scoring system that requires precise measurements and mathematical calculations of cross sectional imaging. Like other nephrometry scores, its implementation has been slowed by required time investment and interobserver variability. We sought to automate this score on preoperative computerized tomography scans by developing an artificial intelligence-generated C-index score. We then aimed to evaluate its ability to predict meaningful oncologic and perioperative outcomes as compared to human-generated C-index nephrometry scores. Methods: 300 patients with preoperative computerized tomography with early arterial contrast phase were identified from a cohort of 544 consecutive patients undergoing surgical extirpation for suspected renal cancer. A deep neural network approach was used to automatically segment kidneys and tumors, and then programed to generate the measurements and calculate C-index score. Human C-index scores were independently calculated by medical personnel blinded to AI-scores. AI- and Human score agreement was assessed using bivariate linear regression correlation and their predictive abilities for both oncologic and perioperative outcomes were assessed using logistic regression and compared with receiver operating characteristic (ROC) curve analyses with measurements of areas under the curve (AUC). Results: Median age was 60 years (IQE 51–68), and 40% were female. Median tumor size was 4.2 cm and 91.3% had malignant tumors. 27% were high stage, 37% high grade, and 63% underwent partial nephrectomy. There was significant agreement between Human scores and AI-scores on linear regression analysis (R2 = 0.738, p <0.0001). Both AI- and Human generated C-index scores similarly predicted meaningful oncologic outcomes, with lower levels of either C-index score associated with increased risk of malignant histology (H-score p = 0.018, AI score p =0.014) high-grade disease (both p <0.0001), and high stage disease (both p <0.0001). Lower levels of either AI or human generated C-index scores also predicted a radical nephrectomy rather than partial nephrectomy surgical approach (both p <0.0001). AUC measurements (Table) were similar but consistently superior for AI generated C-index scores. Conclusions: Fully automated AI-generated C-index scores are comparable to human-generated C-index scores and predict a wide variety of meaningful patient-centered outcomes. Once validated in additional populations, our results suggest that our AI generated C-index could be delivered automatically from a preoperative CT scan to a clinician and patient at the point of care to aid in decision making. [Table: see text]

Does Simplified PADUA Renal (SPARE) Nephrometry scoring system can help predicting renal function outcomes after Robot-Assisted Partial Nephrectomy (RAPN) (UroCCR study 93)?

Does Simplified PADUA Renal (SPARE) Nephrometry scoring system can help predicting renal function outcomes after Robot-Assisted Partial Nephrectomy (RAPN) (UroCCR study 93)?

Three-dimensional topology-based T-index as an indicator of surgical difficulty of partial nephrectomy in patients with small renal mass.

To accurately describe the three-dimensional topology of renal tumors, our study suggests a new nephrometry scoring system, the T-index, that combines information about intraparenchymal extension and peripherality of the renal tumor. This study included 113 patients who underwent partial nephrectomy for small clear cell renal cell carcinoma between 2007 and 2014. Manual segmentation of the renal parenchyma, sinus, and tumor was performed using preoperative computed tomography images. The T-index was calculated by adding the reciprocals of the distances from all points on the tumor-parenchyma interface to the renal sinus. Correlations with perioperative factors and the impact of the T-index on postoperative complications were evaluated and compared with existing nephrometry scoring systems (PADUA, RENAL, contact surface area [CSA], and C-index). The mean value of the T-index among the 113 patients was 116.1±100.5 (1/mm). The T-index showed the strongest correlation with perioperative factors compared with other nephrometry scoring systems. The T-index was able to predict the risk for postoperative complications, either overall (p=0.015) or major complications (p=0.030). A predictive model based on the T-index of the overall postoperative complications presented the best performance (area under the curve, 0.692; 95% CI, 0.599-0.776) compared with other nephrometry scoring systems. The T-index can be considered as a single value comprising key structural indicators for surgical complexity. Our findings suggest that the T-index can provide a quantitative and objective scoring system associated with surgical difficulty and postoperative complications of partial nephrectomy.

Nephrometric scoring system: Recent advances and outlooks.

A nephrometry scoring system is a key standard to evaluate the feasibility of partial nephrectomy (PN). Whether based on two-dimensional or three-dimensional images, simplicity, effectiveness, and practicality are the keys to the nephrometric scoring system. Since the emergence of RENAL score in 2009, numerous scoring systems based on different anatomical parameters are established to seek accurately and few parameters to assess the risk of PN and complications. This study aimed to achieve a three-game winning streak in PN more easily and efficiently (negative resection margin, maximum preservation of normal nephron function, and avoiding short-term and long-term complications). Using PubMed, we counted 28 kinds of nephrometric scoring systems. We considered only English literatures published and excluded editorials, commentaries, and meeting abstracts. To the best of our knowledge, this is to date and most comprehensive summary as well as an outlook of the nephrometric scoring system.

Off-clamp robotic-assisted partial nephrectomy: surgical experience from a single centre.

Robot-assisted partial nephrectomy (RAPN) is a minimally invasive treatment for localized renal tumours, which can sometimes result in extended warm ischaemic time and serious complications. This study reports on surgical outcomes including feasibility, positive margins, and complications during and after surgery. From January 2011 to November 2022, a single centre performed off-clamp sutureless RAPN on 287 patients. The study recorded preoperative patient characteristics, estimated glomerular filtration rate, and tumour features according to the preoperative aspects and dimensions used for an anatomical (PADUA) classification, and utilized the RENAL nephrometry scoring system. Intraoperative details and complications were documented. Postoperative complications within 30 days were classified according to the Clavien-Dindo system. Follow-up appointments were scheduled at 1, 3, and 6 months in the first year, followed by subsequent appointments every 6 months, and then annually. The study included 145 males and 142 females, with a mean age of 58.9 years and a mean body mass index of 26.7 kg/m2. The mean PADUA score was 8.3, the average console time was 83 minutes, and the estimated blood loss was 280 mL. The average hospital stay was 3 days, and no intraoperative complications were observed. However, 4 patients (1.4%) experienced post-operative haemorrhage that required laparotomy (Clavien-Dindo stage IIIB), and 4 patients (1.4%) had positive surgical margins. Off-clamp selective arterial clamping during minimally invasive partial nephrectomy is a safe and feasible approach for small renal tumours. Further randomized prospective studies are required to confirm if RAPN without clamping offers any renal functional benefits and reduces perioperative bleeding complications.

Association of ABC and RENAL Scoring Systems With Morbidity in Partial Nephrectomy.

Different nephrometry scoring systems (NSSs) are used to evaluate the surgical complexity and outcomes of partial nephrectomy (PN) in patients with small renal tumors. This study aimed to assess the validity of nephrometry scoring systems towards aiding the preoperative planning of laparoscopic partial nephrectomy (PN). Data of 77 patients who underwent partial nephrectomy at the Puerto Real University Hospital between January 2011 and December 2017 were retrospectively analyzed. Statistical analyses were carried out to determine whether there was an association between the complexity of the surgical procedure and the assigned nephrometry scores. Operative complications (bleeding volume, conversion to open surgery, perioperative bleeding, and postoperative fistula) were significantly associated with independent variables (age, sex, body mass index, radiological tumor size, and operative ischemia time) and with the classification of patients using arterial-based complexity (ABC) and radius endophytic/exophytic nearness anterior-posterior location (RENAL) scores. There was also a strong correlation between the RENAL and ABC scores [Cramer's V coefficient (0.682) and Fisher's test (p<0.0001)]. The RENAL and ABC scores are associated with the risk of the complexity of partial nephrectomy for T1 renal tumors, even for ≥T1b tumors and/or with complex anatomical features.

A morphology-based nephrometry score to predict pathological upstaging to T3 renal cell carcinoma.

Patients with clinical T1-2 renal cell carcinoma (RCC) upstaging to pathological T3 showed worse survival prognosis than those without upstaging. We aimed to develop and validate a morphology-based nephrometry scoring system for predicting pathological upstaging to T3 of RCC. We retrospectively reviewed 200 patients with clinical T1-2 RCC who underwent surgical treatment. The nephrometry scores were measured through preoperative computed tomography images. The risk factors of pathological upstaging were identified by logistic regression models. The predictive accuracy of a novel morphology-based nephrometry scoring system (M-Index), was compared with R.E.N.A.L (radius, exophytic/endophytic, nearness, anterior/posterior, location), PADUA (preoperative aspects and dimensions used for an anatomic classification), DAP (diameter, axial, polar) and C-Index scores. The upstaging rate of the population was 17% (34 out of 200 patients). The upstaging and non-upstaging groups were comparable in terms of age, gender ratio, body mass index, tumor laterality, and pathological type, while the upstaging group tended to have large tumor diameter, irregular tumor morphology, inner tumor location, and short polar and axial distance. Large tumor diameter refers to larger than 5 cm, while irregular tumor morphology refers to not regular shapes such as round, oval, or lobular. Univariate and multivariate logistic regression analyses showed that tumor morphology [odds ratio (OR) 3.26, 95% confidence interval (CI): 1.79-5.97] and tumor rim location (OR 2.95, 95% CI: 1.16-7.46) were independent risk factors for pathological upstaging. The receiver operating characteristic curve and decision curve analysis (DCA) demonstrated the novel M-Index based on tumor morphology and rim location outperformed R.E.N.A.L, PADUA, DAP, and C-Index in the prediction of pathological upstaging (area under curve 0.756 vs. 0.728 vs. 0.641 vs. 0.661 vs. 0.743). Consisting of fewer non-complex parameters, the M-Index is an intuitive and practical tool with satisfactory predictive power for pathological upstaging to T3 in RCC patients undergoing surgery.

P106 - PERC-score as a nephrometry scoring system in percutaneous tumour ablation: Comparison with RENAL, mRENAL, PADUA and SPARE in a multi-centre series

P106 - PERC-score as a nephrometry scoring system in percutaneous tumour ablation: Comparison with RENAL, mRENAL, PADUA and SPARE in a multi-centre series

SC65 - Perc-score as a nephrometry scoring system in percutaneous tumour ablation: comparison with renal, mrenal, padua and spare in a multi-centre series

SC65 - Perc-score as a nephrometry scoring system in percutaneous tumour ablation: comparison with renal, mrenal, padua and spare in a multi-centre series

Pathological diagnostic nomograms for predicting malignant histology and unfavorable pathology in patients with endophytic renal tumor.

PurposeTo develop and validate nomograms for pre-treatment prediction of malignant histology (MH) and unfavorable pathology (UP) in patients with endophytic renal tumors (ERTs).MethodsWe retrospectively reviewed the clinical information of 3245 patients with ERTs accepted surgical treatment in our center. Eventually, 333 eligible patients were included and randomly enrolled into training and testing sets in a ratio of 7:3. We performed univariable and multivariable logistic regression analyses to determine the independent risk factors of MH and UP in the training set and developed the pathological diagnostic models of MH and UP. The optimal model was used to construct a nomogram for MH and UP. The area under the receiver operating characteristics (ROC) curves (AUC), calibration curves and decision curve analyses (DCA) were used to evaluate the predictive performance of models.ResultsOverall, 172 patients with MH and 50 patients with UP were enrolled in the training set; and 74 patients with MH and 21 patients with UP were enrolled in the validation set. Sex, neutrophil-to-lymphocyte ratio (NLR), R score, N score and R.E.N.A.L. score were the independent predictors of MH; and BMI, NLR, tumor size and R score were the independent predictors of UP. Single-variable and multiple-variable models were constructed based on these independent predictors. Among these predictive models, the malignant histology-risk nomogram consisted of sex, NLR, R score and N score and the unfavorable pathology-risk nomogram consisted of BMI, NLR and R score performed an optimal predictive performance, which reflected in the highest AUC (0.842 and 0.808, respectively), the favorable calibration curves and the best clinical net benefit. In addition, if demographic characteristics and laboratory tests were excluded from the nomograms, only the components of the R.E.N.A.L. Nephrometry Score system were included to predict MH and UP, the AUC decreased to 0.781 and 0.660, respectively (P=0.001 and 0.013, respectively).ConclusionIn our study, the pathological diagnostic models for predicting malignant and aggressive histological features for patients with ERTs showed outstanding predictive performance and convenience. The use of the models can greatly assist urologists in individualizing the management of their patients.

A "3S+f" Nephrometry Score System to Predict the Clinical Outcomes of Laparoscopic Nephron-Sparing Surgery.

BackgroundWhen we treat renal cell carcinoma by laparoscopic nephron-sparing surgery (NSS), it is essential to use an evaluation system to predict clinical outcomes. Hitherto, there are more than a dozen nephrometry score systems. In this study, through assessing the correlations between nephrometry score systems and clinical outcomes, we aim to provide a novel nephrometry score system—the “3S+f” score system—to simplify the evaluation of technical complexity of partial nephrectomy.MethodsWe retrospectively collected the data of 131 patients who underwent NSS, which was performed by a single surgeon (SZ) from January 2013 to July 2018 at Peking University Third Hospital. The “3S+f” score system contains four parameters: “size, side, site, and fat”, all of which can be obtained from preoperative imaging data. We evaluated the correlations between the “3S+f” score and clinical outcomes, and compared R.E.N.A.L. score and PADUA score.ResultsAll the three nephrometry score systems were related to some clinical outcomes in univariate analyses. In multivariate regression models, the “3S+f” score, the R.E.N.A.L. score, and the PADUA score were significantly associated with operative time (p = 0.016, p = 0.035, and p = 0.001, respectively) and warm ischemia time (all p = 0.008, p < 0.001, and p < 0.001, respectively). “3S+f” was also significantly related to extubation time > 5 days (p = 0.018). In predicting operative time > 120 min and extubation time >5 days from ROC curves, the AUCs of the “3S+f” score (0.717 and 0.652, respectively) were larger than both the R.E.N.A.L (0.598 and 0.554, respectively) and PADUA (0.600 and 0.542, respectively) score systems.ConclusionA novel nephrometry score system—the “3S+f” score system—shows equivalent correlation and the ability in predicting clinical outcomes when compared to the R.E.N.A.L. score system and the PADUA score system, which can describe renal tumors.