title: Zonal NePhRO scoring system: a superior renal tumor complexity classification model.
abstract: BACKGROUND
  Since the advent of the first standardized renal tumor complexity system, many subsequent scoring systems have been introduced, many of which are complicated and can make it difficult to accurately measure data end points. In light of these limitations, we introduce the new zonal NePhRO scoring system.
  
  
  METHODS
  The zonal NePhRO score is based on 4 anatomical components that are assigned a score of 1, 2, or 3, and their sum is used to classify renal tumors. The zonal NePhRO scoring system is made up of the (Ne)arness to collecting system, (Ph)ysical location of the tumor in the kidney, (R)adius of the tumor, and (O)rganization of the tumor. In this retrospective study, we evaluated patients exhibiting clinical stage T1a or T1b who underwent open partial nephrectomy performed by 2 genitourinary surgeons. Each renal unit was assigned both a zonal NePhRO score and a RENAL (radius, exophytic/endophytic properties, nearness of tumor to the collecting system or sinus in millimeters, anterior/posterior, location relative to polar lines) score, and a blinded reviewer used the same preoperative imaging study to obtain both scores. Additional data points gathered included age, clamp time, complication rate, urine leak rate, intraoperative blood loss, and pathologic tumor size.
  
  
  RESULTS
  One hundred sixty-six patients underwent open partial nephrectomy. There were 37 perioperative complications quantitated using the validated Clavien-Dindo system; their occurrence was predicted by the NePhRO score on both univariate and multivariate analyses (P = .0008). Clinical stage, intraoperative blood loss, and tumor diameter were all correlated with the zonal NePhRO score on univariate analysis only.
  
  
  CONCLUSIONS
  The zonal NePhRO scoring system is a simpler tool that accurately predicts the surgical complexity of a renal lesion.
authors.affiliation: Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL.
authors.forename: Tariq S
authors.initials: TS
authors.lastname: Hakky
authors.affiliation: Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL.
authors.forename: Adam S
authors.initials: AS
authors.lastname: Baumgarten
authors.affiliation: Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL.
authors.forename: Bryan
authors.initials: B
authors.lastname: Allen
authors.affiliation: Department of Biostatistics, Moffitt Cancer Center, Tampa, FL.
authors.forename: Hui-Yi
authors.initials: HY
authors.lastname: Lin
authors.affiliation: Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL.
authors.forename: Cesar E
authors.initials: CE
authors.lastname: Ercole
authors.affiliation: Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL.
authors.forename: Wade J
authors.initials: WJ
authors.lastname: Sexton
authors.affiliation: Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL. Electronic address: philippe.spiess@moffitt.org.
authors.forename: Philippe E
authors.initials: PE
authors.lastname: Spiess
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000145:classification* / Q000453:epidemiology / Q000601:surgery; D005260:Female; D006801:Humans; D007668:Kidney / Q000473:pathology / Q000601:surgery; D007680:Kidney Neoplasms / Q000145:classification* / Q000453:epidemiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D060787:Neoplasm Grading; D009392:Nephrectomy; D059035:Perioperative Period; D010808:Physical Examination; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Anatomy; Renal; Scoring system; Surgical complexity