Tumor Complexity Predicts Malignant Disease for Small Renal Masses

Mullins, Jeffrey K.; Kaouk, Jihad; Bhayani, Sam B.; Rogers, Craig G.; Stifelman, Michael; Pierorazio, Phillip M.; Tanagho, Youssef S.; Hillyer, Shahab; Kaczmarek, B; Chiu, Yi-Chun; Allaf, Mohamad E.

doi:10.1016/j.juro.2012.08.027

Cited by 43 publications

(46 citation statements)

References 25 publications

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“…Further study is needed to estimate the association of tumour complexity with malignancy among all kidney centre databases similar to the study by Mullins and colleagues. 29 …”

Section: Discussionmentioning

confidence: 99%

Association between R.E.N.A.L nephrometry score and perioperative outcomes following open partial nephrectomy under cold ischemia

Park

Hwang

Kang

et al. 2014

CUAJ

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. Tumour complexity was stratified into 3 categories: low (4-6), moderate (7-9) and high (10-12) complexity. Perioperative outcomes, such as complications, cold ischemic time, estimated blood loss and renal function, were analyzed according to the complexity by NS. Complications were stratified using the Clavien-Dindo classification system. Results: Tumour complexity according to nephrometry score was assessed as low in 16 (16.3%), moderate in 48 (49.0%) and high in 34 (34.7%). The median cold ischemic time did not differ significantly among the 3 groups (36.0 minutes in low-, 40 minutes in moderate-and 43 minutes in the high-complexity group, p = 0.421). Total complications did not differ significantly (2 (2.0%) in low, 4 (4.1%) in moderate and 4 (4.1%) in high, p = 0.984). Each Grade 3 complication occurred in the moderate (urine leakage) and high groups (lymphocele). Postoperative renal functional outcomes were similar among the groups (p = 0.729). Only mean estimated blood loss was significantly different with nephrometry score (p = 0.049). Conclusions:The nephrometry score, as used in an open PN series under cold ischemia, was not significantly associated with perioperative outcomes (i.e., ischemia time, complications, renal functional preservation).

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“…Further study is needed to estimate the association of tumour complexity with malignancy among all kidney centre databases similar to the study by Mullins and colleagues. 29 …”

Section: Discussionmentioning

confidence: 99%

Association between R.E.N.A.L nephrometry score and perioperative outcomes following open partial nephrectomy under cold ischemia

Park

Hwang

Kang

et al. 2014

CUAJ

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“…After PN, an high tumor complexity was associated with higher grade malignancy, 25 and with pathological tumor up-staging. 26 Few studies on highly complex RCC are available, and most with short follow-up, therefore whether the correlation between adverse pathological findings/poor survival outcome and higher nephrometry score is stronger than that with higher TNM stage is still debated.…”

Section: Discussionmentioning

confidence: 96%

Simple enucleation for the treatment of highly complex renal tumors: Perioperative, functional and oncological results

Serni

Vittori

Frizzi

et al. 2015

European Journal of Surgical Oncology (EJSO)

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Aim: To assess the role of simple enucleation (SE) for the treatment of highly complex renal tumors. Methods: Overall, 96 Preoperative Aspects and Dimensions Used for an Anatomical (PADUA) classification score 10 to 13 renal tumors were treated with SE at our institution. All conventional perioperative variables, surgical, functional and oncological results were gathered in a prospectively maintained database. Survival curves were generated using a KaplaneMeier method. Univariate analysis assessed the outcome differences. Results: Mean (AE1s.d.) clinical tumor diameter was 4.8 (AE1.6 cm). 70.8% of patients had !cT1b stage. The PADUA score was recorded as 10, 11, 12 and 13 in 57.3%, 29.2%, 11.5%, and 2.1% of tumors respectively. Overall, 76 patients were treated with an open approach and 20 robotically. Mean warm ischemia time (WIT) was 19.2 min, and WIT greater than 25 min occurred in 14.6% of cases. Positive surgical margin (PSM) rate was 3.6% and trifecta was achieved in 64.3% of patients. Postoperative surgical complications occurred in 24% of patients, with 14.6% Clavien-Dindo grade 1e2, 8.3% grade 3, and 1% grade 4. Five-year cancer specific survival (CSS), recurrent free survival (RFS), and overall survival (OS) rates resulted 96.1%, 90.8% and 88.0%, respectively. Overall, 4.2% of patients experienced progressive disease. At follow-up, the mean decrease of eGFR from preoperative value was 13.9 ml/min. This was not significantly correlated with PADUA score (p ¼ 0.69). The surgical approach was neither a predictor of Trifecta outcome, nor of postoperative complications, WIT >25 min or PSM rate. Conclusions: SE is an effective treatment for highly-complex renal tumors, with a potential key role to widen the NSS (nephron sparing surgery) indications according to guidelines.

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“…Clinical and radiographic characteristics with known associations with the risk of malignancy and unfavorable pathology were chosen for the logistic regression models – notably age [13], sex [13], imaging tumor size[3, 13, 14] and tumor complexity as represented by the R.E.N.A.L. nephrometry score [9, 14, 15]. …”

Section: Methodsmentioning

confidence: 99%

Preoperative predictors of malignancy and unfavorable pathology for clinical T1a tumors treated with partial nephrectomy: A multi-institutional analysis

Ball

Gorin

Bhayani

et al. 2015

Urologic Oncology: Seminars and Original Investigations

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Purpose To determine preoperative predictors associated with RCC and unfavorable pathology in small renal masses treated with partial nephrectomy (PN). Materials and Methods PN records from 5 centers were retrospectively queried for patients with a clinically localized, single tumor < 4 cm on imaging (cT1a). Between 2007 and 2013, 1009 patients met inclusion criteria. Unfavorable pathology was defined as any grade III or IV RCC or tumors upstaged to pathologic T3a disease. Logistic regression models were used to determine preoperative characteristics associated with RCC and with unfavorable pathology. Results A total of 771 (76.4%) patients were found to have RCC and 198 (19.6%) had unfavorable pathology. On multivariate, bootstrap-adjusted logistic regression analysis, factors associated with presence of malignancy were imaging tumor size > 3 cm (OR 1.46, p = 0.040), male sex (OR 1.88, p < 0.0001) and nephrometry score > 8 (OR 1.64, p = 0.005). These same factors were independently associated with risk of unfavorable pathology: size > 3 cm (OR 1.46, p=0.021), male sex (OR 2.35, p < 0.0001) and nephrometry score > 8 (OR 1.49, p =0.015). The c statistic was 0.62 for the predicting malignancy and 0.63 for unfavorable pathology. Conclusions In this multi-institutional cohort, male sex, imaging tumor size >3 cm, and nephrometry score >8 were predictors of RCC and adverse pathology following PN. These factors may assist in risk stratification and selective renal mass biopsy prior to decision making. Further studies are necessary to validate these findings.

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Tumor Complexity Predicts Malignant Disease for Small Renal Masses

Abstract: High R.E.N.A.L nephrometry score and male gender are associated with an increased risk of malignancy and high grade malignancy in tumors treated with partial nephrectomy.

Cited by 43 publications

References 25 publications

Association between R.E.N.A.L nephrometry score and perioperative outcomes following open partial nephrectomy under cold ischemia

Association between R.E.N.A.L nephrometry score and perioperative outcomes following open partial nephrectomy under cold ischemia

Simple enucleation for the treatment of highly complex renal tumors: Perioperative, functional and oncological results

Preoperative predictors of malignancy and unfavorable pathology for clinical T1a tumors treated with partial nephrectomy: A multi-institutional analysis

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