1. Renal Tumor Invasion Depth and Diameter are the Two Most Accurate Anatomical Features Regarding the Choice of Radical Versus Partial Nephrectomy
- Author
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Harry Nisen, Petrus Järvinen, Harri Visapää, Riikka Järvinen, Tuomas P. Kilpeläinen, Kimmo Taari, Sara V Tornberg, Clinicum, Urologian yksikkö, Department of Surgery, and HUS Abdominal Center
- Subjects
Male ,Databases, Factual ,medicine.medical_treatment ,030232 urology & nephrology ,NEPHROMETRY SCORING SYSTEM ,Logistic regression ,Nephrectomy ,Cohort Studies ,0302 clinical medicine ,invasion index ,Neoplasm Metastasis ,diameter ,INDEX ,Finland ,Preoperative Aspects and Dimensions Used for an Anatomical ,OUTCOMES ,medicine.diagnostic_test ,Area under the curve ,ASSOCIATION ,Middle Aged ,Renal tumor ,Prognosis ,PERIOPERATIVE COMPLICATIONS ,Kidney Neoplasms ,Tumor Burden ,Survival Rate ,Treatment Outcome ,030220 oncology & carcinogenesis ,Female ,Radiology ,ASSISTED PARTIAL NEPHRECTOMY ,Invasion depth ,medicine.medical_specialty ,urologia ,Tumor invasion ,Risk Assessment ,Disease-Free Survival ,03 medical and health sciences ,Preoperative Care ,MANAGEMENT ,medicine ,Humans ,Neoplasm Invasiveness ,MASSES ,Aged ,Neoplasm Staging ,Retrospective Studies ,R.E.N.A.L ,Receiver operating characteristic ,business.industry ,Magnetic resonance imaging ,3126 Surgery, anesthesiology, intensive care, radiology ,PREDICTING COMPLEXITY ,Confidence interval ,renal cell ,Surgery ,Logistic Models ,ROC Curve ,Laparoscopy ,Lymph Nodes ,business - Abstract
Background and Aims: To evaluate simple tumor characteristics (renal tumor diameter and parenchymal invasion depth) compared with more complex classifications, that is, Renal Tumor Invasion Index (RTII) and Preoperative Aspects and Dimensions Used for an Anatomical classification, in predicting the type of nephrectomy (radical vs partial) performed. Material and Methods: A total of 915 patients who had undergone either partial nephrectomy ( n = 388, 42%) or radical nephrectomy ( n = 527, 58%) were identified from the Helsinki University Hospital kidney tumor database between 1 January 2006 and 31 December 2014. Tumor maximum diameter and depth of invasion into the parenchyma were estimated from computed tomography or magnetic resonance imaging images and compared with Preoperative Aspects and Dimensions Used for an Anatomical and Renal Tumor Invasion Index. Logistic regression and receiver operating curves were used to compare the parameters at predicting the type of nephrectomy. Results and conclusion: All the anatomical variables of receiver operating curve/area under the curve analyses were significant predictors for the type of nephrectomy. Parenchymal invasion (area under the curve 0.91; 95% confidence interval, 0.89–0.93), RTII (area under the curve 0.91; 95% confidence interval, 0.89–0.93), and diameter (area under the curve 0.91; 95% confidence interval, 0.89–0.93) performed significantly better than Preoperative Aspects and Dimensions Used for an Anatomical classification (area under the curve 0.88; 95% confidence interval, 0.85–0.89). In multivariable analysis, invasion depth was the best predictor of nephrectomy type (percentage correct, 85.6%). Addition of one anatomic parameter into the model of non-anatomical cofactors improved the accuracy of the model significantly, but the addition of more parameters did not. Parenchymal invasion depth and tumor diameter are the most accurate anatomical features for predicting the nephrectomy type. All potential anatomical classification systems should be tested against these two simple characteristics.
- Published
- 2017