TY - JOUR
T1 - Utility of the R.E.N.A.L. nephrometry scoring system in objectifying treatment decision-making of the enhancing renal mass
AU - Canter, Daniel
AU - Kutikov, Alexander
AU - Manley, Brandon
AU - Egleston, Brian
AU - Simhan, Jay
AU - Smaldone, Marc
AU - Teper, Ervin
AU - Viterbo, Rosalia
AU - Chen, David Y.T.
AU - Greenberg, Richard E.
AU - Uzzo, Robert G.
N1 - Copyright © 2011 Elsevier Inc. All rights reserved.
PY - 2011/11
Y1 - 2011/11
N2 - Objective: To evaluate the treatment patterns of solid renal masses according to the quantifiable anatomic features using nephrometry. The treatment of localized renal cell carcinoma remains overly subjective. The R.E.N.A.L. (radius, exophytic/endophytic properties, nearness of tumor to the collecting system or sinus in millimeters, anterior/posterior, location relative to polar lines) nephrometry score quantifies the salient characteristics of renal mass anatomy in an objective and reproducible manner. Methods: Nephrometry scores were available in 615 patients in our prospective kidney tumor database (2000-2010). The nephrometry score sum and its individual component scores were analyzed to determine their relationship to treatment approach. Results: The median age, age-adjusted Charlson co-morbidity index, and estimated glomerular filtration rate was 60 years (range 25-89), 2 (range 0-10), and 80.5 mL/min (range 5.1-120.0), respectively. Increasing tumor complexity, as measured by a greater overall nephrometry score was associated with both radical nephrectomy and open partial nephrectomy (P <.0001). Compared with patients who underwent partial nephrectomy, the patients treated with radical nephrectomy had a significantly greater size (R), central proximity (N), and location (L) component scores (P <.001). Furthermore, tumors treated with radical nephrectomy were more often hilar (P <.001). Similarly, compared with minimally invasive partial nephrectomy (laparoscopic or robotic), open partial nephrectomy was associated with an increasing individual component score for size, endophytic, and central proximity to the collecting system (P <.001) and nonpolar location (P =.016). Conclusion: The R.E.N.A.L nephrometry score standardizes the reporting of solid renal masses and appears to effectively stratify by treatment type. Although only 1 part of the treatment decision-making process, nephrometry aids in objectifying previously subjective measures.
AB - Objective: To evaluate the treatment patterns of solid renal masses according to the quantifiable anatomic features using nephrometry. The treatment of localized renal cell carcinoma remains overly subjective. The R.E.N.A.L. (radius, exophytic/endophytic properties, nearness of tumor to the collecting system or sinus in millimeters, anterior/posterior, location relative to polar lines) nephrometry score quantifies the salient characteristics of renal mass anatomy in an objective and reproducible manner. Methods: Nephrometry scores were available in 615 patients in our prospective kidney tumor database (2000-2010). The nephrometry score sum and its individual component scores were analyzed to determine their relationship to treatment approach. Results: The median age, age-adjusted Charlson co-morbidity index, and estimated glomerular filtration rate was 60 years (range 25-89), 2 (range 0-10), and 80.5 mL/min (range 5.1-120.0), respectively. Increasing tumor complexity, as measured by a greater overall nephrometry score was associated with both radical nephrectomy and open partial nephrectomy (P <.0001). Compared with patients who underwent partial nephrectomy, the patients treated with radical nephrectomy had a significantly greater size (R), central proximity (N), and location (L) component scores (P <.001). Furthermore, tumors treated with radical nephrectomy were more often hilar (P <.001). Similarly, compared with minimally invasive partial nephrectomy (laparoscopic or robotic), open partial nephrectomy was associated with an increasing individual component score for size, endophytic, and central proximity to the collecting system (P <.001) and nonpolar location (P =.016). Conclusion: The R.E.N.A.L nephrometry score standardizes the reporting of solid renal masses and appears to effectively stratify by treatment type. Although only 1 part of the treatment decision-making process, nephrometry aids in objectifying previously subjective measures.
KW - Adult
KW - Aged
KW - Aged, 80 and over
KW - Humans
KW - Kidney Neoplasms/pathology
KW - Middle Aged
KW - Nephrectomy
KW - Organ Size
KW - Prospective Studies
UR - http://www.scopus.com/inward/record.url?scp=80455129068&partnerID=8YFLogxK
U2 - 10.1016/j.urology.2011.04.035
DO - 10.1016/j.urology.2011.04.035
M3 - Article
C2 - 22054378
SN - 0090-4295
VL - 78
SP - 1089
EP - 1094
JO - Urology
JF - Urology
IS - 5
ER -