title: Tumor size and invasiveness matters for partial nephrectomy: External validation and modification of the arterial based complexity score.
abstract: BACKGROUND
  Outcome of partial nephrectomy (PN) depends on anatomic features of the renal tumor, which can be assessed by nephrometry scores. The aim was to externally validate and refine the Arterial Based Complexity (ABC) score and to compare it to established systems.
  
  
  METHODS
  Tumors of 300 patients undergoing PN were categorized according to the ABC, RENAL, and PADUA score. Size and tumor invasiveness were combined to form the ABCD score. Correlation analysis and multivariate logistic regression was performed to validate and compare the respective scores as predictors of surgical outcome.
  
  
  RESULTS
  The ABC score shows significant correlation with ischemia time (IT) (P < 0.01), opening of the collecting system (CS) (P < 0.01), and conversion to nephrectomy (P = 0.01). In the multivariate analysis, the ABC score was predictive for on-clamp excision (P < 0.01) and opening of the CS (P < 0.01) only. The RENAL and ABCD scores were independent predictors for complications (P = 0.02, P = 0.05), IT (P < 0.01, P = 0.03), on clamp excision (P < 0.01, P < 0.01), and opening of the CS (P < 0.01, P < 0.01).
  
  
  CONCLUSIONS
  The ABC score correlates well with surgical parameters. Expanding the score by tumor diameter gives the ABCD system. It has similar predictive effectiveness to the well-established RENAL score, but features simplicity by only assessing invasiveness and tumor size.
authors.affiliation: Department of Urology, University Medical Centre Mannheim, Mannheim, Germany.
authors.forename: Maximilian C
authors.initials: MC
authors.lastname: Kriegmair
authors.affiliation: Medical Faculty Mannheim, Department of Medical Statistics, University of Heidelberg, Mannheim, Germany.
authors.forename: Svetlana
authors.initials: S
authors.lastname: Hetjens
authors.affiliation: Department of Urology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Mandel
authors.affiliation: Department of Urology, University Medical Centre Mannheim, Mannheim, Germany.
authors.forename: Jula
authors.initials: J
authors.lastname: Wadle
authors.affiliation: Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Mannheim, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Budjan
authors.affiliation: Department of Urology, University Medical Centre Mannheim, Mannheim, Germany.
authors.forename: Maurice S
authors.initials: MS
authors.lastname: Michel
authors.affiliation: Department of Urology, University Medical Centre Mannheim, Mannheim, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Pfalzgraf
authors.affiliation: Department of Urology, University Medical Centre Mannheim, Mannheim, Germany.
authors.forename: Nina
authors.initials: N
authors.lastname: Wagener
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000098:blood supply / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology; D015203:Reproducibility of Results; D016896:Treatment Outcome; D055815:Young Adult
keywords: RENAL score; nephrometry; outcome; partial nephrectomy; renal tumor