Comparison of RENAL, PADUA, and C-index scoring systems in predicting perioperative outcomes after nephron sparing surgery

Abstract

Introduction and Objective:The RENAL, PADUA and centrality index (C-index) nephrometry scoring systems (SS) have been individually evaluated for their role in predicting trifecta outcomes after nephron-sparing surgery (NSS). However, there is little data on their comparative superiority. The present study was designed to evaluate the predictive value of three SS and to assess interobserver reliability.Materials and Methods:Fifty patients undergoing NSS at our center between January 2014 and April 2016 were included in the study. The demographic details were noted. Images (computed tomography [CT] scans or magnetic resonance imaging) were reviewed by a urologist and a radiologist independently and RENAL, PADUA, and C-index were calculated. The correlation between these scoring system and trifecta outcomes were calculated.Results:The RENAL and PADUA score did not correlate with any of the perioperative parameters. However, C-index had a significant correlation with operative time (OT) (P = 0.02) and trifecta outcomes (P < 0.05). There was an excellent concordance between the two observers in scoring the RENAL score (α = 0.915; intraclass correlation coefficient [ICC] = 0.814) and PADUA score (α = 0.816; ICC = 0.689 [P < 0.001]). There was lesser although acceptable concordance in the calculation of C-index (ICC −0.552; α −0.711).Conclusions:There is good correlation among all the 3 SS. C-index has lower reproducibility due to difficult mathematical calculation but correlated best with trifecta outcomes.

Predicting Strict Trifecta Outcomes after Robot-Assisted Partial Nephrectomy: Comparison of RENAL, PADUA, and C-Index Scores

“…The correlation between urologist and radiologist seems to be sufficient to recommend the use of RENAL, PADUA, and C-index scores. Likewise, good concordance amongst readers was found in a study on interobserver variability of the RENAL, PADUA, and C-index for robotic and laparoscopic PN patients ( 8 ). There are many studies investigating the nephrometry scores and PN outcomes.…”

“…This study revealed that only C-index correlated with the Trifecta achievement. However, there was no univariate and multivarite analyses in this study ( 8 ). Contradictory to the above mentioned studies, Acar et al noted that none of the RENAL, PADUA, and C-index scores showed significant association to predict Trifecta outcomes.…”

“…The objective of PN is to achieve a satisfactory oncological outcome and minimize complications while preserving (6)(7)(8)(9)(10). The only use of WIT≤25 min does not apply properly to demonstrate long term renal functional outcomes.…”

“…The external validation studies demonstrated that nephrometry scores associated with perioperative and renal functional outcomes ( 14 – 16 , 23 ). However, there are only four studies on comparative analysis of nephrometry scores to predict the Trifecta success ( 8 , 20 , 23 , 24 ). In our study, RENAL, PADUA, and C-index scores were all helpful to independently predict the strict Trifecta outcomes.…”

“…Some authors have also reported a warm ischemia time, (WIT) ≤25 min, to be a component of the Trifecta ( 6 , 7 ). In a study conducted by Sharma et al, Trifecta was defined as WIT <30 min ( 8 ). In several studies, the authors have applied strict Trifecta (negative surgical margin, no complications of grade 3 or higher, renal function loss <15%, and WIT≤25 min) to evaluate the renal function preservation more precisely ( 9 , 10 ).…”