title: Diameter-Axial-Polar Nephrometry is Predictive of Surgical Outcomes Following Partial Nephrectomy.
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.
authors.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).
authors.forename: Mingmin
authors.initials: M
authors.lastname: Li
authors.forename: Yi
authors.initials: Y
authors.lastname: Gao
authors.forename: Jiwen
authors.initials: J
authors.lastname: Cheng
authors.forename: Le
authors.initials: L
authors.lastname: Qu
authors.forename: Junming
authors.initials: J
authors.lastname: Chen
authors.forename: Chen
authors.initials: C
authors.lastname: Cai
authors.forename: Bing
authors.initials: B
authors.lastname: Xu
authors.forename: Peng
authors.initials: P
authors.lastname: Li
authors.forename: Yi
authors.initials: Y
authors.lastname: Bao
authors.forename: Zhipeng
authors.initials: Z
authors.lastname: Xu
authors.forename: Yifan
authors.initials: Y
authors.lastname: Xu
authors.forename: Dengshuang
authors.initials: D
authors.lastname: Wu
authors.forename: Zhenjie
authors.initials: Z
authors.lastname: Wu
authors.forename: Linhui
authors.initials: L
authors.lastname: Wang
authors.forename: Yinghao
authors.initials: Y
authors.lastname: Sun
mesh_terms: D000328:Adult; D002292:Carcinoma, Renal Cell / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D002681:China / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000503:physiopathology; D007680:Kidney Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000639:trends; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D016017:Odds Ratio; D009929:Organ Size; D011184:Postoperative Period; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012371:Robotics; D015996:Survival Rate / Q000639:trends; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome