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      The value of renal score in both determining surgical strategies and predicting complications for renal cell carcinoma: A systematic review and meta‐analysis

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          Abstract

          Objectives

          Radical nephrectomy (RN) was the standard treatment for renal cell carcinoma (RCC). However, recent studies have found that partial nephrectomy (PN) could achieve similar effects as radical nephrectomy, and has the advantages of less bleeding and shorter hospital stay. The choice of surgical strategies has become a concern of clinicians, which could be guided by renal score introduced by Kutikov et al Therefore, we conducted this meta‐analysis to clarify the value of renal score of determining surgical strategies and predicting complications.

          Methods

          The keywords “RENAL score,” “renal nephrometry score,” or “nephrometry score” were used to retrieve electronic databases for relevant literature up to Feb 2020, including PubMed, Web of Science, and the Cochrane library. Surgical strategies and complications are outcome measures. Risk ratio (RR) with 95% confidence intervals (CI) is applied to assess the effect size.

          Results

          A total of 20 studies met the selection criteria for meta‐analysis. There was significant difference in RN operation rate for each subgroup (low‐moderate: RR = 3.50, 95% Cl = 2.60‐4.71, P < .001; low‐high: RR = 6.29, 95% Cl = 4.40‐9.00, P < .001; moderate‐high: RR = 1.80, 95% Cl = 1.39‐2.32, P < .001).The overall incidence of complications from high renal score group was significantly higher than that in low renal score group (low‐moderate: RR = 1.32, 95% Cl = 1.03‐1.69, P = .026; low‐high: RR = 2.45, 95% Cl = 1.48‐4.07, P = .001; moderate‐high: RR = 1.75, 95% Cl = 1.17‐2.61, P = .007).

          Conclusions

          This meta‐analysis indicated that renal score is an efficient tool for determining surgical strategies and predicting complications in PN. More prospective research is essential to verify the predictive value of renal score.

          Abstract

          The predictive value of renal score is unclear. We retrieved all studies on renal score and performed a meta‐analysis of surgical strategies and postoperative complications. The results show that renal score is an objective and effective tool for predicting surgical strategies and complications after PN. 

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          Most cited references37

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          Preoperative aspects and dimensions used for an anatomical (PADUA) classification of renal tumours in patients who are candidates for nephron-sparing surgery.

          Besides clinical tumour size, other anatomical aspects of the renal tumour are routinely considered when evaluating the feasibility of elective nephron-sparing surgery (NSS). To propose an original, standardised classification of renal tumours suitable for NSS based on their anatomical features and size and to evaluate the ability of this classification to predict the risk of overall complications resulting from the surgery. We enrolled prospectively 164 consecutive patients who underwent NSS for renal tumours at a tertiary academic referral centre from January 2007 to December 2008. Open partial nephrectomy without vessel clamping. All tumours were classified by integrating size with the following anatomical features: anterior or posterior face, longitudinal, and rim tumour location; tumour relationships with renal sinus or urinary collecting system; and percentage of tumour deepening into the kidney. We generated an algorithm evaluating each anatomical parameter and tumour size (the preoperative aspects and dimensions used for an anatomical [PADUA] score) to predict the risk of complications. Overall rates of complication were significantly correlated to all the evaluated anatomical aspects, excluding clinical size and anterior or posterior location of the tumour. By multivariate analysis, PADUA scores were independent predictors of the occurrence of any grade complications (hazard ratio [HR] for score 8-9 vs 6-7: 14.535; HR for score ≥10 vs 6-7: 30.641). Potential limitations were the limited number of patients with T1b tumours included in the study and the lack of laparoscopically treated patients. Further external validation of the PADUA score is needed. The PADUA score is a simple anatomical system that can be used to predict the risk of surgical and medical perioperative complications in patients undergoing open NSS. The use of an appropriate score can help clinicians stratify patients suitable for NSS into subgroups with different complication risks and can help researchers evaluate the real comparability among patients undergoing NSS with different surgical approaches.
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            Kidney tumor location measurement using the C index method.

            Tumor location assessment is essential to plan nephron sparing kidney surgery. We describe a method to quantify the proximity of kidney tumors to the renal central sinus for reporting and surgical management. Centrality index scoring was done using standard 2-dimensional cross-sectional computerized tomography images in 133 consecutive patients undergoing transperitoneal laparoscopic partial nephrectomy between September 2003 and November 2005. The Pythagorean theorem was used to calculate the distance from tumor center to kidney center. The distance was divided by tumor radius to obtain the centrality index. We assessed the correlation of the centrality index with laparoscopic partial nephrectomy operative parameters and the urological complication rate. Centrality index accuracy and interobserver variability were assessed. A centrality index of 0 equates to a tumor that is concentric with the center of the kidney. A centrality index of 1 equates to a tumor with its periphery touching the kidney center. As the centrality index increases, the tumor periphery becomes more distant from the kidney center. Multivariate regression analysis revealed an association of the centrality index with warm ischemia time (p = 0.004), which is a surrogate for technical complexity. Interobserver correlation of centrality index values was greater than 93% with an estimated learning curve of 14 cases required for measurement variability to decrease below 10% of the mean centrality index of 10 consecutive cases. Centrality index scoring provides a clinically useful measure of tumor centrality. This system may allow improved clinical and radiological assessment of kidney tumors, and improved reporting of quantitative tumor site. 2010 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
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              The results of radical nephrectomy for renal cell carcinoma.

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                Author and article information

                Contributors
                mingchenseu@126.com
                Journal
                Cancer Med
                Cancer Med
                10.1002/(ISSN)2045-7634
                CAM4
                Cancer Medicine
                John Wiley and Sons Inc. (Hoboken )
                2045-7634
                12 April 2020
                June 2020
                : 9
                : 11 ( doiID: 10.1002/cam4.v9.11 )
                : 3944-3953
                Affiliations
                [ 1 ] Department of Urology Affiliated Zhongda Hospital of Southeast University Nanjing China
                [ 2 ] Department of Urology Funing People's Hospital Yancheng Jiangsu China
                [ 3 ] Department of Urology The Second People's Hospital of Taizhou Taizhou Jiangsu China
                [ 4 ] Department of Environmental Genomics Jiangsu Key Laboratory of Cancer Biomarkers, Prevention and Treatment Collaborative Innovation Center for Cancer Personalized Medicine Nanjing Medical University Nanjing China
                Author notes
                [*] [* ] Correspondence

                Bin Xu, The Affiliated ZhongDa Hospital of Southeast University, Nanjing City, Jiangsu Province, China.

                Mulong Du, Nanjing Medical University, China.

                Ming Chen, The Affiliated ZhongDa Hospital of Southeast University, Nanjing City, Jiangsu Province, China.

                Emails: njxb1982@ 123456126.com (B.X.); dumulong@ 123456163.com (M.D.); mingchenseu@ 123456126.com (M.C.)

                Author information
                https://orcid.org/0000-0002-3572-6886
                Article
                CAM42993
                10.1002/cam4.2993
                7286475
                32281277
                e628549b-1a3b-45c6-be3f-37747a7a6f8a
                © 2020 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 30 November 2019
                : 29 February 2020
                : 29 February 2020
                Page count
                Figures: 3, Tables: 3, Pages: 10, Words: 5971
                Funding
                Funded by: The National Natural Science Foundation of China , open-funder-registry 10.13039/501100001809;
                Award ID: 81070592
                Award ID: 81202034
                Award ID: 81202268
                Award ID: 81300472
                Award ID: 81370849
                Award ID: 81672551
                Award ID: 81872089
                Funded by: Six talent peaks project in Jiangsu Province, Jiangsu Provincial Medical Innovation Team
                Award ID: CXTDA2017025
                Funded by: Natural Science Foundation of Jiangsu Province , open-funder-registry 10.13039/501100004608;
                Award ID: BK2012336
                Award ID: BK20150642
                Award ID: BK20161434
                Award ID: BL2013032
                Funded by: Jiangsu Provincial Medical Talent
                Award ID: ZDRCA2016080
                Categories
                Original Research
                Cancer Biology
                Original Research
                Custom metadata
                2.0
                June 2020
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.8.4 mode:remove_FC converted:10.06.2020

                Oncology & Radiotherapy
                complications,meta‐analysis,renal cell carcinoma,renal score,surgical strategies

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