Critical Appraisal of the PADUA Classification and Assessment of the R.E.N.A.L. Nephrometry Score in Patients Undergoing Partial Nephrectomy
- 1 July 2011
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Journal of Urology
- Vol. 186 (1), 42-46
- https://doi.org/10.1016/j.juro.2011.03.020
Abstract
We validated the PADUA classification and assessed the R.E.N.A.L. nephrometry score to predict perioperative complications of partial nephrectomy. In addition, we assessed their interobserver variability, and the ability to predict the use of ischemia and ischemia time. Data from consecutive cases of partial nephrectomy with or without ischemia from 3 centers were retrospectively collected. Associations between preoperative variables and complications were evaluated in univariate and multivariate analyses. Reproducibility was assessed by determining Fleiss' generalized kappa and intraclass correlation coefficients in a subcohort scored by 3 physicians with different degrees of urological expertise. A total of 134 partial nephrectomies were included in the study and 31 cases (23%) presented with complications. On univariate analyses complications were associated with age (p = 0.02), tumor size on computerized tomography (p = 0.01), pT stage (p = 0.001), and PADUA (p = 0.001) and R.E.N.A.L. scores (p = 0.02). In 3 multivariate models PADUA score 10 or greater (OR 3.98, p = 0.01), R.E.N.A.L. score 9 or greater (OR 4.21, p = 0.02), tumor size in cm (OR 1.35, p = 0.02) and age (OR 1.04, p = 0.04) were independent predictors of complications. The R.E.N.A.L. nephrometry score predicted the use of ischemia (p = 0.03) and both scores predicted ischemia time (both p <0.001). Kappa was 0.37 to 0.80 for PADUA components and 0.23 to 0.73 for R.E.N.A.L. components. The intraclass correlation coefficient was 0.73 for PADUA and 0.70 for R.E.N.A.L. score. The highest categories of PADUA and R.E.N.A.L. scores as well as clinical tumor size predict the risk of perioperative complications of partial nephrectomy. Both scores can indicate ischemia time. Their reproducibility is substantial but the implementation of these systems in clinical practice needs further refinement.Keywords
This publication has 20 references indexed in Scilit:
- EAU Guidelines on Renal Cell Carcinoma: The 2010 UpdateEuropean Urology, 2010
- Nephrectomy Induced Chronic Renal Insufficiency is Associated With Increased Risk of Cardiovascular Death and Death From Any Cause in Patients With Localized cT1b Renal MassesJournal of Urology, 2010
- Preoperative Aspects and Dimensions Used for an Anatomical (PADUA) Classification of Renal Tumours in Patients who are Candidates for Nephron-Sparing SurgeryEuropean Urology, 2009
- Guideline for Management of the Clinical T1 Renal MassJournal of Urology, 2009
- Long-Term Outcomes After Nephron Sparing Surgery for Renal Cell Carcinoma Larger Than 4 cmJournal of Urology, 2008
- A Prospective Randomized EORTC Intergroup Phase 3 Study Comparing the Complications of Elective Nephron-Sparing Surgery and Radical Nephrectomy for Low-Stage Renal Cell CarcinomaEuropean Urology, 2006
- Chronic kidney disease after nephrectomy in patients with renal cortical tumours: a retrospective cohort studyThe Lancet Oncology, 2006
- Elective Nephron Sparing Surgery Should Become Standard Treatment for Small Unilateral Renal Cell Carcinoma: Long-term Survival Data of 216 PatientsEuropean Urology, 2006
- SAFETY AND EFFICACY OF PARTIAL NEPHRECTOMY FOR ALL T1 TUMORS BASED ON AN INTERNATIONAL MULTICENTER EXPERIENCEJournal of Urology, 2004
- Nephron Sparing Surgery for Appropriately Selected Renal Cell Carcinoma Between 4 and 7 Cm Results in Outcome Similar to Radical NephrectomyJournal of Urology, 2004