title: The Zhongshan score: a novel and simple anatomic classification system to predict perioperative outcomes of nephron-sparing surgery.
abstract: In the zero ischemia era of nephron-sparing surgery (NSS), a new anatomic classification system (ACS) is needed to adjust to these new surgical techniques. We devised a novel and simple ACS, and compared it with the RENAL and PADUA scores to predict the risk of NSS outcomes. We retrospectively evaluated 789 patients who underwent NSS with available imaging between January 2007 and July 2014. Demographic and clinical data were assessed. The Zhongshan (ZS) score consisted of three parameters. RENAL, PADUA, and ZS scores are divided into three groups, that is, high, moderate, and low scores. For operative time (OT), significant differences were seen between any two groups of ZS score and PADUA score (all P < 0.05). For ZS score, patients with moderate and high scores had longer warm ischemia time (WIT) and greater increase in SCr compared with low score (all P < 0.05). What is more, the differences between moderate and high scores classified by ZS score were borderline but trending toward significance in WIT (P = 0.064) and increase in SCr (P = 0.052). Interestingly, RENAL showed no significant difference between moderate and high complexity in OT, WIT, estimated blood loss, and increase in SCr. Compared with patients with a low score of ZS, those with a high or moderate score had 8.1-fold or 3.3-fold higher risk of surgical complications, respectively (all P < 0.05). As for RENAL score, patients with a high or moderate score had 5.7-fold or 1.9-fold higher risk of surgical complications, respectively (all P < 0.05). Patients with a high or moderate score of PADUA had 2.3-fold or 2.8-fold higher risk of surgical complications, respectively (all P < 0.05). In the ROC curve analysis, ZS score had the greatest AUC for surgical complications (AUC = 0.632) and the conversion to radical nephrectomy (AUC = 0.845) (all P < 0.05). In conclusion, the ability of ZS score to predict the surgical complexity and surgical complications of NSS is better than RENAL and PADUA scores. ZS score could be used to reflect the surgical complexity and predict the risk of surgical complications in patients undergoing NSS.
authors: From the Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China.
authors: Lin
authors: L
authors: Zhou
authors: Jianming
authors: J
authors: Guo
authors: Hang
authors: H
authors: Wang
authors: Guomin
authors: G
authors: Wang
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D003404:Creatinine / Q000097:blood; D013505:Digestive System Surgical Procedures; D005260:Female; D006470:Hemorrhage / Q000453:epidemiology; D006801:Humans; D007680:Kidney Neoplasms / Q000145:classification* / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009399:Nephrons; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors
chemical_list: D003404:Creatinine
references: J Urol. 2000 Mar;163(3):737-43
references: 10687967
references: J Urol. 2004 Jul;172(1):49-53
references: 15201735
references: Eur Urol. 2011 Oct;60(4):724-30
references: 21621910
references: BJU Int. 2011 Apr;107(7):1054-8
references: 21040369
references: Clin Genitourin Cancer. 2014 Feb;12(1):e13-8
references: 24120084
references: Eur Urol. 2011 May;59(5):849-55
references: 21146917
references: J Endourol. 2014 Apr;28(4):487-92
references: 24437510
references: N Engl J Med. 2010 Feb 18;362(7):624-34
references: 20164486
references: BJU Int. 2011 Sep;108(6):876-81
references: 21166761
references: Urology. 2005 Nov;66(5):985-9
references: 16286108
references: J Urol. 2009 Jun;181(6):2438-43; discussion 2443-5
references: 19371905
references: J Urol. 2008 Dec;180(6):2363-8; discussion 2368-9
references: 18930264
references: BJU Int. 2012 Oct;110(7):956-60
references: 22300498
references: Eur Urol. 2009 Nov;56(5):786-93
references: 19665284
references: PLoS One. 2014 Feb 21;9(2):e89155
references: 24586557
references: J Urol. 2008 Oct;180(4):1273-8
references: 18707711
references: Eur Urol. 2011 Jan;59(1):128-34
references: 20971550
references: J Urol. 2009 Sep;182(3):844-53
references: 19616235
references: Scand J Urol. 2014 Feb;48(1):41-51
references: 23781885
references: Eur Urol. 2010 Sep;58(3):398-406
references: 20633979
references: Eur Urol. 2012 Jan;61(1):67-74
references: 21908096
references: J Endourol. 2011 Dec;25(12):1921-4
references: 21905850
references: J Urol. 1998 Apr;159(4):1156-60
references: 9507821
references: Ann Surg. 2004 Aug;240(2):205-13
references: 15273542
references: J Urol. 2010 May;183(5):1708-13
references: 20299047
references: J Urol. 2004 Apr;171(4):1443-6
references: 15017194
references: Ann Intern Med. 2009 May 5;150(9):604-12
references: 19414839
references: J Urol. 2006 Mar;175(3 Pt 1):849-52
references: 16469563
references: Eur Urol. 2012 Oct;62(4):617-8
references: 22704367
references: Br J Surg. 1954 Sep;42(172):132-9
references: 13209036
references: Crit Care. 2004 Aug;8(4):R204-12
references: 15312219
references: Eur Urol. 2010 Sep;58(3):340-5
references: 20825756
references: BJU Int. 2008 Aug;102(3):301-4
references: 18410433
references: J Urol. 2012 Aug;188(2):384-90
references: 22698624