DAP及 RENAL score對腎細胞癌病患接受機器人輔助部分腎切除的長期預後價值之比較
連繼志1、黃昭淵1、蔣智宏1,2、蒲永孝1
1國立台灣大學醫學院附設醫院 泌尿部，2台北榮民總醫院員山分院 泌尿部/教學研究部
Comparing the Value of DAP Score and RENAL Score for Long-Term Outcomes in Robot-assisted Partial Nephrectomy
for Renal Cell Carcinoma Patients
Chi-Chih Lien,1 Chao-Yuan Huang,1 Chih-Hung Chiang, 2 Yeong-Shiao Pu1
1Department of Urology, National Taiwan University Hospital, Taipei, Taiwan
2Department of Urology / Medical Research and Education, Taipei Veterans General Hospital, Yuan-Shan Branch
BACKGROUND/PURPOSE: Few studies reported the value of DAP (diameter-axial-polar) score in robot-assisted partial nephrectomy (RaPN) for renal cell carcinoma in Taiwanese population. This study aimed at demonstrating that DAP score as an effective tool, which is not inferior to RENAL score for predicting long-term surgical, oncological and functional outcomes of RaPN for kidney cancer.
METHODS: We retrospectively collected clinical data of 108 patients with pathologically confirmed RCC, receiving RaPN during the period, 2012-2017. The patients were stratified as low, intermediate, and high complexity according to the RENAL and DAP scoring system. We analyzed the warm ischemia time (WIT), cancer-specific survival, radiographic progression-free survival, positive rate of surgical margin, renal function (estimated glomerular filtration rate) of pre-operative period, post-operative 1st/6th month, and post-operative complication.
RESULTS: The median follow-up was 36 months. The 3-year cancer specific survival rate in all patients was 98.4%. The 3-year radiographic progression-free survival was 95.2%. There were 4 patients (3.6%) having positive surgical margin. The largest decrease of renal function from pre- to post-operative 6th month was noted in the intermediate RENAL score group. In our study, the predictive value of long-term outcomes of DAP score were not inferior to RENAL score, including WIT in 20 minutes (AUC of DAP vs RENAL=0.77 vs 0.70), WIT in 25 minutes (AUC of DAP vs RENAL=0.77 vs 0.74), positive margin (AUC of DAP vs RENAL=0.61 vs 0.34), 3-year radiographic local recurrence (AUC of DAP vs RENAL=0.92 vs 0.86), complication (AUC of DAP vs RENAL=0.56 vs 0.53), but failed to change of CKD status (AUC of DAP vs RENAL=0.41 vs 0.40). Our study also demonstrated that age may be an independent factor for progression to CKD after RaPN (Odds ratio=1.068, 95% CI=1.022-1.116, p=0.013). Complications occurred in 22 patients (20.4%), and the most common post-operative complications were bleeding (12.2%), followed by post-operative fever (0.5%) and urinary leakage (0.3%).
CONCLUSION: DAP score is an effective tool for predicting peri-operative outcomes of RaPN, especially in 3-year local recurrence, positive margin and WIT (warm ischemia time) less than 25 minutes.