PMID- 30256079
OWN - NLM
STAT- MEDLINE
DCOM- 20191122
LR  - 20191122
IS  - 1827-1758 (Electronic)
IS  - 0393-2249 (Linking)
VI  - 71
IP  - 3
DP  - 2019 Jun
TI  - Improved prediction of nephron-sparing surgery versus radical nephrectomy by the 
      optimized R.E.N.A.L. Score in patients undergoing surgery for renal masses.
PG  - 249-257
LID - 10.23736/S0393-2249.18.03134-X [doi]
AB  - BACKGROUND: One major objective of currently available morphometric scores (MS) 
      for renal masses, i.e., R.E.N.A.L., PADUA classification, Centrality-Index, is 
      the prediction of type of surgery (nephron-sparin surgery [NSS] or radical 
      nephrectomy [RN]). METHODS: Based on a prospective study protocol, various MS 
      were assigned and calculated for 108 patients undergoing surgical treatment for 
      renal masses at a single academic center. MS calculation was based on 
      preoperative computed-tomography or magnet-resonance-imaging and performed by two 
      independent readers blinded for surgical approach and outcome. Multivariable 
      logistic-regression- and ROC-analyses were performed to assess the predictive 
      value of various MS for surgical approach and the correlation of clinical 
      parameters with nephrectomy type. Furthermore, the association with perioperative 
      outcome parameters was evaluated. RESULTS: None of the tested MS was 
      significantly superior to tumor size alone (area under the curve [AUC]=0.82) in 
      predicting RN, with Centrality-Index showing the best association (AUC=0.88). 
      Based on these findings, a simplified and optimized R.E.N.A.L. Score 
      (optR.E.N.A.L.) was developed with different weightings of included parameters, 
      which did not only show a significantly enhanced association with surgery type 
      (AUC=0.93) than tumor size, but also outperformed all 1st and 2nd generation MS 
      tested in the study cohort. Besides a modest correlation with postoperative 
      change in renal function, no association with perioperative outcome variables was 
      found for all MS including optR.E.N.A.L. CONCLUSIONS: optR.E.N.A.L. represents a 
      promising improvement of the preexisting R.E.N.A.L. Score with higher predictive 
      ability for nephrectomy type than established MS and may serve as a benchmarking 
      tool for nephrectomy assessment and comparison of surgical strategies.
FAU - Sterzik, Alexander
AU  - Sterzik A
AD  - Department of Radiology, Ludwig-Maximilians-University, Munich, Germany.
FAU - Solyanik, Olga
AU  - Solyanik O
AD  - Department of Radiology, Ludwig-Maximilians-University, Munich, Germany.
FAU - Eichelberg, Christian
AU  - Eichelberg C
AD  - Department of Urology, Caritas-Hospital St. Josef, University of Regensburg, 
      Regensburg, Germany.
FAU - Jost, Marion
AU  - Jost M
AD  - Department of Urology, Caritas-Hospital St. Josef, University of Regensburg, 
      Regensburg, Germany.
FAU - Graser, Anno
AU  - Graser A
AD  - Department of Radiology, Ludwig-Maximilians-University, Munich, Germany.
FAU - Lausenmeyer, Eva-Maria
AU  - Lausenmeyer EM
AD  - Department of Urology, Caritas-Hospital St. Josef, University of Regensburg, 
      Regensburg, Germany.
FAU - Otto, Wolfgang
AU  - Otto W
AD  - Department of Urology, Caritas-Hospital St. Josef, University of Regensburg, 
      Regensburg, Germany.
FAU - Waidelich, Raphaela
AU  - Waidelich R
AD  - Department of Urology, Ludwig-Maximilians-University, Munich, Germany.
FAU - Stief, Christian G
AU  - Stief CG
AD  - Department of Urology, Ludwig-Maximilians-University, Munich, Germany.
FAU - Burger, Maximilian
AU  - Burger M
AD  - Department of Urology, Caritas-Hospital St. Josef, University of Regensburg, 
      Regensburg, Germany.
FAU - May, Matthias
AU  - May M
AD  - Department of Urology, St. Elisabeth-Hospital Straubing, Straubing, Germany - 
      may@klinikum-straubing.de.
FAU - Brookman-May, Sabine D
AU  - Brookman-May SD
AD  - Department of Urology, Ludwig-Maximilians-University, Munich, Germany.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
DEP - 20180924
PL  - Italy
TA  - Minerva Urol Nefrol
JT  - Minerva urologica e nefrologica = The Italian journal of urology and nephrology
JID - 8503649
SB  - IM
MH  - Aged
MH  - *Algorithms
MH  - Female
MH  - Humans
MH  - Kidney/diagnostic imaging/surgery
MH  - Kidney Neoplasms/diagnostic imaging/*surgery
MH  - Magnetic Resonance Imaging
MH  - Male
MH  - Middle Aged
MH  - Nephrectomy/*methods
MH  - Nephrons/diagnostic imaging/*surgery
MH  - Predictive Value of Tests
MH  - Prospective Studies
MH  - Tomography, X-Ray Computed
MH  - Treatment Outcome
MH  - Urologic Surgical Procedures/*methods
EDAT- 2018/09/27 06:00
MHDA- 2019/11/23 06:00
CRDT- 2018/09/27 06:00
PHST- 2018/09/27 06:00 [pubmed]
PHST- 2019/11/23 06:00 [medline]
PHST- 2018/09/27 06:00 [entrez]
AID - S0393-2249.18.03134-X [pii]
AID - 10.23736/S0393-2249.18.03134-X [doi]
PST - ppublish
SO  - Minerva Urol Nefrol. 2019 Jun;71(3):249-257. doi: 10.23736/S0393-2249.18.03134-X. 
      Epub 2018 Sep 24.