title: The comparison of three renal tumor scoring systems: C-Index, P.A.D.U.A., and R.E.N.A.L. nephrometry scores.
abstract: OBJECTIVE
  The centrality-index (C-Index), preoperative aspects and dimensions used for anatomic (P.A.D.U.A.) classification, and radius.exophyic/endophytic.nearness.anterior/posterior.location (R.E.N.A.L.) nephrometry schemes were developed as standardized scoring systems (SS) to quantify anatomic characteristics of kidney tumors. The objective of this study was to establish reliability and assess relationships between these three SS and perioperative and postoperative variables.
  
  
  METHODS
  A retrospective chart review was performed in 101 patients who underwent laparoscopic partial nephrectomy. The nephrometry schemes were correlated with intraoperative and postoperative parameters using Spearman correlations. In addition, interobserver reliability was assessed on 50 of the patients by interclass correlations comparing the scores assigned by two residents and one fellow who reviewed preoperative CT studies of these patients.
  
  
  RESULTS
  The interobserver correlation was 0.84 for the C-Index, 0.81 for the P.A.D.U.A., and 0.92 for the R.E.N.A.L. scoring systems, demonstrating excellent interobserver reliability. All three SS were significantly associated with warm ischemia time (WIT) (C-Index, P=-0.44; P.A.D.U.A., P=0.25; R.E.N.A.L., P=0.32) and percent change in creatinine level (C-Index, P=- 0.33; P.A.D.U.A., P=0.37; R.E.N.A.L., P=0.37). There were no significant associations between any of the three SS assessed and the occurrence of complications, operative time, or estimated blood loss. No significant correlation was found between the P.A.D.U.A. and R.E.N.A.L. SS and length of stay; however, C-Index did show a significant relationship for patients with lower scores having longer hospital stays (P=-0.21).
  
  
  CONCLUSIONS
  All three scoring systems demonstrated reliability among observers and represent novel methods of quantitatively describing renal tumors. They were all associated with WIT, percent change in creatinine level, and tumor size. They did not, however, correlate with any other perioperative parameters investigated. At this time, these SS provide a common language for describing renal tumors.
authors: The Arthur Smith Institute for Urology, Hofstra North Shore-LIJ School of Medicine, North Shore Long Island Jewish Health System, New Hyde Park, New York 11042, USA. zho0616@yahoo.com
authors: Zhamshid
authors: Z
authors: Okhunov
authors: Soroush
authors: S
authors: Rais-Bahrami
authors: Arvin K
authors: AK
authors: George
authors: Nikhil
authors: N
authors: Waingankar
authors: Brian
authors: B
authors: Duty
authors: Sylvia
authors: S
authors: Montag
authors: Lisa
authors: L
authors: Rosen
authors: Suzanne
authors: S
authors: Sunday
authors: Manish A
authors: MA
authors: Vira
authors: Louis R
authors: LR
authors: Kavoussi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003710:Demography; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D007680:Kidney Neoplasms / Q000145:classification* / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care