BACKGROUND Functional outcome is an important issue in nephron-sparing surgery. Various nephrometries have been developed to predict renal function preservation. The aim of this study was to examine the applicability of R.E.N.A.L., PADUA, C-index, and mathematical tumor contact surface area (CSA) in predicting ipsilateral renal function after partial nephrectomy using radio-isotope scans. METHODS We performed this retrospective study in patients who underwent partial nephrectomy between May 2013 and April 2017, and used abdominopelvic computerized tomography or magnetic resonance imaging to obtain R.E.N.A.L., C-index, and CSA. Renal function was measured by 99mTc mercaptoacetyltriglycine (MAG3). We evaluated correlations between nephrometries and perioperative parameters, and comparatively analyzed different nephrometries to determine the predictive ability in the percent change of effective renal plasma flow of the affected kidney. RESULTS Three, two, and 35 patients received partial nephrectomy in open, laparoscopic, and robotic approaches, respectively. The median (IQR) tumor size was 3.13 (2.4) cm. The median (IQR) R.E.N.A.L., PADUA, C-index, and CSA scores were 7 (3), 8 (2), 2.01 (1.87), and 14.14 (19.25) cm2, respectively. Spearman correlation analysis showed that four nephrometries were correlated with each other. The strongest correlations were between CSA and C-index (coefficient: - 0.885, p < 0.001), followed by R.E.N.A.L. and PADUA (coefficient: 0.778, p < 0.001). Ischemia time was significantly correlated with R.EN.A.L. (coefficient: 0.35, p = 0.025), PADUA (coefficient: 0.42, p = 0.007), C-index (coefficient: - 0.45, p = 0.004), and CSA (coefficient: 0.41, p = 0.009). In multivariate analysis, PADUA significantly affected ischemia time (p = 0.04). The percent change in effective renal plasma flow (PCE) of the operated kidney was correlated with PADUA (coefficient: 0.48 p = 0.002), C-index (coefficient: - 0.74, p < 0.001), and CSA (coefficient: 0.75, p < 0.001). Only CSA and C-index independently affected PCE (both p < 0.05) in multivariate analysis. In ROC curve analysis, both C-index and CSA could predict 20% change in effective renal plasma flow (AUC: 0.91 vs 0.86, p = 0.2) of the affected kidney. CONCLUSIONS We suggest using PADUA to evaluate surgical complexity and ischemia time. Regarding the accuracy of the prediction of post-operative ipsilateral renal function, both CSA and C-index outperformed R.E.N.A.L. and PADUA nephrometries.

中文翻译：

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RENAL，PADUA，C-index，CSA肾测量系统在部分肾切除术后预测同侧肾功能中的作用。

背景技术功能结果是保留肾单位的手术中的重要问题。已经开发出各种浊度法来预测肾功能的保存。这项研究的目的是检查使用放射性同位素扫描在部分肾切除术后预测同侧肾脏功能中RENAL，PADUA，C指数和数学肿瘤接触表面积（CSA）的适用性。方法我们对2013年5月至2017年4月间部分肾切除术的患者进行了这项回顾性研究，并使用腹部骨盆电脑断层扫描或磁共振成像获得RENAL，C指数和CSA。肾功能通过99mTc巯基乙酰基三甘氨酸（MAG3）测量。我们评估了肾结石术与围手术期参数之间的相关性，并比较分析了不同的浊度法，以确定患病肾脏的有效肾脏血浆流量百分比变化的预测能力。结果分别有3例，2例和35例患者接受了开放，腹腔镜和机器人方式的部分肾切除术。中位（IQR）肿瘤大小为3.13（2.4）厘米。RENAL，PADUA，C-index和CSA分数的中位数（IQR）分别为7（3），8（2），2.01（1.87）和14.14（19.25）cm2。Spearman相关分析表明，四个浊度相互关联。CSA和C指数之间的相关性最强（系数：-0.885，p <0.001），其次是RENAL和PADUA（系数：0.778，p <0.001）。缺血时间与R.EN.AL（系数：0.35，p = 0.025），PADUA（系数：0.42，p = 0.007）显着相关，C指数（系数：-0.45，p = 0.004）和CSA（系数：0.41，p = 0.009）。在多变量分析中，PADUA显着影响缺血时间（p = 0.04）。手术肾脏的有效肾血浆流量（PCE）的变化百分比与PADUA（系数：0.48 p = 0.002），C-指数（系数：-0.74，p <0.001）和CSA（系数：0.75，p）相关<0.001）。在多变量分析中，只有CSA和C指数独立影响PCE（均p <0.05）。在ROC曲线分析中，C指数和CSA均可以预测受影响肾脏的有效肾血浆流量变化20％（AUC：0.91 vs 0.86，p = 0.2）。结论我们建议使用PADUA评估手术的复杂性和缺血时间。关于预测术后同侧肾功能的准确性，CSA和C指数均优于RENAL