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Diameter-Axial-Polar Nephrometry is Predictive of Surgical Outcomes Following Partial Nephrectomy.

Li M, Gao Y, Cheng J, Qu L, Chen J, Cai C, Xu B, Li P, Bao Y, Xu Z, Xu Y, Wu D, Wu Z, Wang L, Sun Y - Medicine (Baltimore) (2015)

Bottom Line: The DAP sum score (odds ratio [OR]: 1.749; 95% confidence interval [CI] 1.379-2.220; P < 0.001) and conventional laparoscopy and laparo-endoscopic single-site (CL&LESS) surgery versus the open surgical approach (OR: 5.736; 95% CI: 2.529-13.011; P < 0.001) independently predicted an ischemia time >20 minutes.Furthermore, the DAP score × ischemia time interactions were statistically significant (P < 0.001).We confirmed the predictive value of the DAP nephrometry score with respect to ischemia time and renal functional decline in an independent external cohort of patients undergoing PN.The effect of the DAP score on renal functional decline partially depends on that of ischemia time, and the individual component DAP scores may have different effects on clinical outcomes.

View Article: PubMed Central - PubMed

Affiliation: From the Department of Radiology, Changhai Hospital (ML, BX); Department of Urology, Changzheng Hospital, Second Military Medical University, Shanghai (YG, LQ, JC, PL, YB, ZX, YX, DW, ZW, LW); Department of Urology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning (JC); Department of Special Clinics, Changhai Hospital (CC); Kidney Cancer Center (ZW, LW, YS); and Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, P. R. China (YS).

ABSTRACT
This study sought to evaluate the predictive value of the DAP (diameter-axial-polar) nephrometry system on surgical outcomes following partial nephrectomy (PN).This was a retrospective study of 237 patients who underwent open or minimally invasive PN for renal tumors at a single tertiary care center between 2009 and 2013. The primary outcomes included ischemia time >20 minutes and percentage of estimated glomerular filtration rate (eGFR) decline >10%. Statistical analysis was performed to study associations and predictions.The DAP sum score exhibited a statistically significant correlation with ischemia time, operative time (OT), estimated blood loss (EBL), length of hospital stay (LOS), and percent change in eGFR. The DAP sum score (odds ratio [OR]: 1.749; 95% confidence interval [CI] 1.379-2.220; P < 0.001) and conventional laparoscopy and laparo-endoscopic single-site (CL&LESS) surgery versus the open surgical approach (OR: 5.736; 95% CI: 2.529-13.011; P < 0.001) independently predicted an ischemia time >20 minutes. Similarly, the DAP sum score (OR: 1.297; 95% CI 1.051-1.602; P = 0.016), age-weighted Charlson comorbidity index (CCI) (OR: 4.730; 95% CI 1.463-15.291; P = 0.009), EBL (OR 2.433; 95% CI 1.095-5.407; P = 0.029), and ischemia time (OR 3.332; 95% CI 1.777-6.249; P < 0.001) were identified as independent predictors of eGFR decline >10%. Furthermore, the DAP score × ischemia time interactions were statistically significant (P < 0.001).We confirmed the predictive value of the DAP nephrometry score with respect to ischemia time and renal functional decline in an independent external cohort of patients undergoing PN. The effect of the DAP score on renal functional decline partially depends on that of ischemia time, and the individual component DAP scores may have different effects on clinical outcomes.

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Related in: MedlinePlus

Histogram demonstrating the distribution of the DAP score and its categories. DAP = diameter-axial-polar.
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Figure 1: Histogram demonstrating the distribution of the DAP score and its categories. DAP = diameter-axial-polar.

Mentions: Table 1 presents the clinical and pathological data of the 237 patients included in the present study. There were 64 (27%), 94 (39.6%), 8 (3.4%), and 71 (30%) patients who underwent open, CL, LESS, and robotic PN, respectively. The median patient age was 51 years (IQR: 43–60) with a median tumor size of 3 cm (IQR: 2.3–4). The median value of the DAP score was 6 (IQR: 5–7), and the median value of the DAP size-adjusted score was 4 (IQR: 3–5). The median ischemia time was 23 minutes (IQR: 16.5–28). The median follow-up time was 18 months (IQR: 6–24). Figure 1 presents the histogram analysis of the DAP score distribution. The DAP sum score as well as its component scores of diameter and axial scoring were normally distributed, although the polar scoring tended to exhibit an even distribution.


Diameter-Axial-Polar Nephrometry is Predictive of Surgical Outcomes Following Partial Nephrectomy.

Li M, Gao Y, Cheng J, Qu L, Chen J, Cai C, Xu B, Li P, Bao Y, Xu Z, Xu Y, Wu D, Wu Z, Wang L, Sun Y - Medicine (Baltimore) (2015)

Histogram demonstrating the distribution of the DAP score and its categories. DAP = diameter-axial-polar.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4554132&req=5

Figure 1: Histogram demonstrating the distribution of the DAP score and its categories. DAP = diameter-axial-polar.
Mentions: Table 1 presents the clinical and pathological data of the 237 patients included in the present study. There were 64 (27%), 94 (39.6%), 8 (3.4%), and 71 (30%) patients who underwent open, CL, LESS, and robotic PN, respectively. The median patient age was 51 years (IQR: 43–60) with a median tumor size of 3 cm (IQR: 2.3–4). The median value of the DAP score was 6 (IQR: 5–7), and the median value of the DAP size-adjusted score was 4 (IQR: 3–5). The median ischemia time was 23 minutes (IQR: 16.5–28). The median follow-up time was 18 months (IQR: 6–24). Figure 1 presents the histogram analysis of the DAP score distribution. The DAP sum score as well as its component scores of diameter and axial scoring were normally distributed, although the polar scoring tended to exhibit an even distribution.

Bottom Line: The DAP sum score (odds ratio [OR]: 1.749; 95% confidence interval [CI] 1.379-2.220; P < 0.001) and conventional laparoscopy and laparo-endoscopic single-site (CL&LESS) surgery versus the open surgical approach (OR: 5.736; 95% CI: 2.529-13.011; P < 0.001) independently predicted an ischemia time >20 minutes.Furthermore, the DAP score × ischemia time interactions were statistically significant (P < 0.001).We confirmed the predictive value of the DAP nephrometry score with respect to ischemia time and renal functional decline in an independent external cohort of patients undergoing PN.The effect of the DAP score on renal functional decline partially depends on that of ischemia time, and the individual component DAP scores may have different effects on clinical outcomes.

View Article: PubMed Central - PubMed

Affiliation: From the Department of Radiology, Changhai Hospital (ML, BX); Department of Urology, Changzheng Hospital, Second Military Medical University, Shanghai (YG, LQ, JC, PL, YB, ZX, YX, DW, ZW, LW); Department of Urology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning (JC); Department of Special Clinics, Changhai Hospital (CC); Kidney Cancer Center (ZW, LW, YS); and Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, P. R. China (YS).

ABSTRACT
This study sought to evaluate the predictive value of the DAP (diameter-axial-polar) nephrometry system on surgical outcomes following partial nephrectomy (PN).This was a retrospective study of 237 patients who underwent open or minimally invasive PN for renal tumors at a single tertiary care center between 2009 and 2013. The primary outcomes included ischemia time >20 minutes and percentage of estimated glomerular filtration rate (eGFR) decline >10%. Statistical analysis was performed to study associations and predictions.The DAP sum score exhibited a statistically significant correlation with ischemia time, operative time (OT), estimated blood loss (EBL), length of hospital stay (LOS), and percent change in eGFR. The DAP sum score (odds ratio [OR]: 1.749; 95% confidence interval [CI] 1.379-2.220; P < 0.001) and conventional laparoscopy and laparo-endoscopic single-site (CL&LESS) surgery versus the open surgical approach (OR: 5.736; 95% CI: 2.529-13.011; P < 0.001) independently predicted an ischemia time >20 minutes. Similarly, the DAP sum score (OR: 1.297; 95% CI 1.051-1.602; P = 0.016), age-weighted Charlson comorbidity index (CCI) (OR: 4.730; 95% CI 1.463-15.291; P = 0.009), EBL (OR 2.433; 95% CI 1.095-5.407; P = 0.029), and ischemia time (OR 3.332; 95% CI 1.777-6.249; P < 0.001) were identified as independent predictors of eGFR decline >10%. Furthermore, the DAP score × ischemia time interactions were statistically significant (P < 0.001).We confirmed the predictive value of the DAP nephrometry score with respect to ischemia time and renal functional decline in an independent external cohort of patients undergoing PN. The effect of the DAP score on renal functional decline partially depends on that of ischemia time, and the individual component DAP scores may have different effects on clinical outcomes.

Show MeSH
Related in: MedlinePlus