A novel multiplex score to predict outcomes of partial nephrectomy for multiple tumors.

BACKGROUND The RENAL nephrometry score (RNS) is widely used to describe renal mass complexity and inform patient counseling for partial nephrectomy (PN). However, in cases with multiple tumors, it is unknown which features drive perioperative outcomes. OBJECTIVE To employ a novel scoring equation (multiplex score [MS]) derived from RNS to assess outcomes of multiplex PN at our institution. DESIGN, SETTING, AND PARTICIPANTS A total of 62 consecutive multiplex PN (median (range) # tumors = 4(2-11), 65% robotic) were performed by a single surgeon. The MS was defined a priori as a weighted score derived from RNS (# low risk ([LR] lesions) + 2*(# intermediate risk [IR]) + 4*(# high risk [HR]) based on published complication rates. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS MS was dichotomized into favorable/unfavorable based on median score. Patient outcomes were maintained prospectively. MS was compared with other potential RNS derived scoring systems. RESULTS AND LIMITATION A total of 249 tumors were scored. Median (range) MS was 6(range 2-20, IQR 3-8). Complications occurred in 10 patients (16.1%). Only 1 complication occurred in the favorable MS(<6) group, and MS was associated with perioperative complication (P = 0.02) and blood loss (P < .001). When compared to other potential scoring systems, MS had the best area under the curve (AUC) to predict operative complications (0.75). CONCLUSIONS The novel MS was associated with complications and blood loss. This tool may facilitate standardized reporting of complexity for multiplex series, with special relevance for hereditary cancer syndromes. PATIENT SUMMARY For patients who have one kidney tumor, there are established scoring systems to help patients and surgeons decide on the surgical plan. However currently, for patients with more than one renal tumor, there is no such scoring system. Here, we present the "Multiplex Score" to aid shared-decision-making in cases with more than one renal tumor.

[1]  Mark W. Ball,et al.  X-Capsular Incision for Tumor Enucleation (X-CITE)-Technique: A method to maximize renal parenchymal preservation for completely endophytic renal tumors. , 2021, Urology.

[2]  Gongxian Wang,et al.  Robot‐assisted versus laparoscopic partial nephrectomy for anatomically complex T1b renal tumors with a RENAL nephrometry score ≥7: A propensity score‐based analysis , 2019, Cancer medicine.

[3]  R. Autorino,et al.  Predictive Value of Nephrometry Scores in Nephron-sparing Surgery: A Systematic Review and Meta-analysis. , 2019, European urology focus.

[4]  Mark W. Ball,et al.  Inherited kidney cancer syndromes. , 2019, Current opinion in urology.

[5]  Mark W. Ball,et al.  A comparison of outcomes for standard and multiplex partial nephrectomy in a solitary kidney: The National Cancer Institute experience. , 2019, Urologic oncology.

[6]  W. Linehan,et al.  The Metabolic Basis of Kidney Cancer. , 2019, Cancer discovery.

[7]  P. Shao,et al.  Factors Influencing the Feasibility of Segmental Artery Clamping During Retroperitoneal Laparoscopic Partial Nephrectomy. , 2019, Urology.

[8]  Oguz Akin,et al.  Interobserver variability of R.E.N.A.L., PADUA, and centrality index nephrometry score systems , 2015, World Journal of Urology.

[9]  R. Uzzo,et al.  Patients with anatomically "simple" renal masses are more likely to be placed on active surveillance than those with anatomically "complex" lesions. , 2014, Urologic oncology.

[10]  A. Metwalli,et al.  Nephron-sparing surgery for multifocal and hereditary renal tumors , 2014, Current opinion in urology.

[11]  R. Uzzo,et al.  Active surveillance of small renal masses , 2013, Nature Reviews Urology.

[12]  R. Uzzo,et al.  Utility of the R.E.N.A.L. nephrometry scoring system in objectifying treatment decision-making of the enhancing renal mass. , 2011, Urology.

[13]  R. Uzzo,et al.  Objective measures of renal mass anatomic complexity predict rates of major complications following partial nephrectomy. , 2011, European urology.

[14]  W. Linehan,et al.  Feasibility and outcomes of partial nephrectomy for resection of at least 20 tumors in a single renal unit. , 2010, The Journal of urology.

[15]  Robert G Uzzo,et al.  The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth. , 2009, The Journal of urology.

[16]  N. Demartines,et al.  Classification of Surgical Complications: A New Proposal With Evaluation in a Cohort of 6336 Patients and Results of a Survey , 2004, Annals of Surgery.