PD3-6: The role of RENAL, PADUA, C-index, CSA nephrometry systems in predicting individual renal function after partial nephrectomy
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  • 06-27,
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腎臟腫瘤量表R.E.N.A.L, PADUA,C-index, CSA對於預測部分腎切除術後患側腎功能的應用
王又德1、黃志平1、張兆祥1、吳錫金2、楊啟瑞1、王又平3、謝博帆1
1.中國醫藥大學附設醫院泌尿 2.中國醫藥大學附設醫院北港分院泌尿部3.台中榮民總醫院放射部
The Role of RENAL, PADUA, C-index, CSA Nephrometry Systems in Predicting Individual Renal Function After Partial Nephrectomy
Yu-De Wang1, Chi-Ping Huang1,2, Chao-Hsiang Chang1,2, Hsi-Chin Wu2,3, Che-Rei Yang1, Yu-Ping Wang 4, Po-Fan Hsieh1,2
1Department of Urology, China Medical University Hospital, Taichung, Taiwan
3Department of Urology, China Medical University Beigang Hospital
4Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan
 
Purpose:
We examined the applicability of R.E.N.A.L, P.A.D.U.A, C-index, and mathematical tumor contact surface area in predicting individual renal function after partial nephrectomy by using Tc-99m mercaptoacetyltriglycine (MAG3). 
Materials and Methods:
We performed a retrospective study in patients who underwent partial nephrectomy between May 2013 and April 2017. Based on abdominopelvic computerized tomography or magnetic resonance imaging, we obtained the R.E.N.A.L, P.A.D.U.A, C-index, and mathematical tumor contact surface area(CSA). We evaluated the correlation between nephrometries and perioperative parameters. And we comparatively analyzed different nephrometries to determine the predictability of individual post-operative renal function.
Results:
There were 3, 2, and 35 patients receiving partial nephrectomy in open, laparoscopic, and robotic approach respectively. The mean±SD tumor size was 3.89± 2.23 cm, CSA was 17.21±10.9 cm2, the median (IQR) R.E.N.A.L was 7(3), the median (IQR) P.A.D.U.A was 8(2), the mean±SD C-index 2.53±1.65. Spearman correlation showed 4 nephrometries were moderate to strong correlated with each other. In multivariate analysis R.E.N.A.L(p=0.03) significantly affected ischemia time only if exclude P.A.D.U.A in multivariate analysis and vice versa(p=0.004). CSA(p=0.003) and C-index(p=0.03) independently affected percent change of effective renal plasma flow (p<0.001). In ROC curve analysis, both C-index and CSA equally able to predict the 20% change of effective renal plasma flow (AUC: 0.91 vs 0.86 p=0.2)
Conclusion:
We suggest using first generation nephromtries, R.E.N.A.L and P.A.D.U.A, to evaluate the surgical complexity and ischemia time. Regarding precise prediction in post-operative individual renal function. Both CSA and C-index were effective and validated.
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    2019-06-27 20:16:25
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    TUA人資客服組
    部門 :
    台灣泌尿科醫學會
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