Peritumoral Artery Scoring System: a Novel Scoring System to Predict Renal Function Outcome after Laparoscopic Partial Nephrectomy

Abstract

The present study aimed to assess the impact of peritumoral artery characteristics on renal function outcome prediction using a novel Peritumoral Artery Scoring System based on computed tomography arteriography. Peritumoral artery characteristics and renal function were evaluated in 220 patients who underwent laparoscopic partial nephrectomy and then validate in 51 patients with split and total glomerular filtration rate (GFR). In particular, peritumoral artery classification and diameter were measured to assign arteries into low, moderate, and high Peritumoral Artery Scoring System risk categories. Univariable and multivariable logistic regression analyses were then used to determine risk factors for major renal functional decline. The Peritumoral Artery Scoring System and four other nephrometry systems were compared using receiver operating characteristic curve analysis. The Peritumoral Artery Scoring System was significantly superior to the other systems for predicting postoperative renal function decline (p < 0.001). In receiver operating characteristic analysis, our category system was a superior independent predictor of estimated glomerular filtration rate (eGFR) decline (area-under-the-curve = 0.865, p < 0.001) and total GFR decline (area-under-the-curve = 0.796, p < 0.001), and split GFR decline (area-under-the-curve = 0.841, p < 0.001). Peritumoral artery characteristics were independent predictors of renal function outcome after laparoscopic partial nephrectomy.

Predictive Value of Nephrometry Scores in Nephron-sparing Surgery: A Systematic Review and Meta-analysis

“…A pooled analysis was not feasible for the other nephrometry scores because only one study per nephrometry score was available. The DAP score (p = 0.018) [49] and PASS (p = 0.02) [18] were independent predictors of renal function variation. PADUA (p = 0.05) [52] and RAIV (p = 0.052) [18] demonstrated a sort of correlation with renal function variation but they did not achieved the usual levels of statistical significance.…”

“…Meta-analysis of new-onset CKD was feasible for the RENAL score only, but it did not predict it (p = 0.086; Table 2 and the Supplementary material) [38,41,70]. In terms of renal function variation, continuous [18,70] and categorical RENAL scores [19,63] were independent predictors of an estimated glomerular filtration rate (eGFR) increase (OR: 1.28; 95% CI: 1.07, 1.53; p = 0.006, and OR: 5.64; 95% CI: 2.22, 14.32; p < 0.001, respectively). A pooled analysis was not feasible for the other nephrometry scores because only one study per nephrometry score was available.…”

“…The four categories assessed (1, 2, 3S, and 3 H) are linked to the neoplasm contact with interlobular or arcuate, interlobar, segmental, or hilum arteries, respectively [14]. Another vasculature-based score is the Peritumoral Artery Scoring System (PASS) [18]. It is a three-dimensionbased score that ranks tumor dissection difficulty according to the number and diameter of peritumoral arteries.…”

“…Description of included studies, and quality and bias assessment Overall, 51 studies meeting our inclusion criteria were identified and considered for the analysis [8][9][10][11]15,17,18,20,. Except for one prospective randomized trial [71], all the studies were retrospective.…”

“…Since then, several other scoring systems have been conceptualized and reported in an effort to improve the predictive value and promote clinical applicability ( Fig. 1) [2,3,[5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. While comparisons among the different systems remain sparse, RENAL and PADUA remain the most known and used ones in the literature [21,22].…”