title: Analysis of the RENAL and mRENAL Scores and the Relative Importance of Their Components in the Prediction of Complications and Local Progression after Percutaneous Renal Cryoablation.
abstract: OBJECTIVE
  To determine if modified RENAL (mRENAL) score and its individual components have superior predictive value relative to the RENAL nephrometry score in prediction of complications and recurrence after percutaneous renal cryoablation.
  
  
  METHODS
  Primary masses treated with CT-guided percutaneous renal cryoablation between June 2007 and May 2016 were retrospectively reviewed. RENAL and mRENAL scores were used to stratify masses into low, medium, and high complexity tertiles. Complications were characterized by SIR criteria. Predictors of complications and local progression were analyzed using multivariate logistic regression and Kaplan-Meier analysis.
  
  
  RESULTS
  There were 95 renal cryoablation procedures in 86 patients. Of ablations, 89 had at least 1 follow-up imaging study, with median follow-up of 29 months. There were 11 (12.4%) complications, including 5 (6.5%) major complications. Mass complexity, as measured by mRENAL complexity tertile, was associated with increased risk of complications on multivariate analysis (P = .045). Endophytic location was the only individual ordinal component of the RENAL and mRENAL scores associated with complications (P = .021). Local progression occurred in 7 (8.3%) masses. Complexity as measured by either scoring system was not associated with local progression. Only diameter > 3 cm was associated with increased risk of local progression (hazard ratio = 9.9, 95% confidence interval = 2.1-45, P = .003).
  
  
  CONCLUSIONS
  mRENAL score was predictive of complications and tumor size was predictive of recurrence. Use of mRENAL score for complications and tumor size for recurrence should allow for simpler risk stratification and more accurate patient counseling.
authors.affiliation: Department of Radiology, Northwestern University Feinberg School of Medicine, 676 North St. Clair Street, Ste 800, Chicago, IL 60611.
authors.forename: Samdeep K
authors.initials: SK
authors.lastname: Mouli
authors.affiliation: Department of Radiology, Northwestern University Feinberg School of Medicine, 676 North St. Clair Street, Ste 800, Chicago, IL 60611. Electronic address: josephlmcdevitt@icloud.com.
authors.forename: Joseph L
authors.initials: JL
authors.lastname: McDevitt
authors.affiliation: Department of Radiology, Northwestern University Feinberg School of Medicine, 676 North St. Clair Street, Ste 800, Chicago, IL 60611.
authors.forename: Yu-Kai
authors.initials: YK
authors.lastname: Su
authors.affiliation: Department of Radiology, Northwestern University Feinberg School of Medicine, 676 North St. Clair Street, Ste 800, Chicago, IL 60611.
authors.forename: Ann B
authors.initials: AB
authors.lastname: Ragin
authors.affiliation: Department of Statistics, Northwestern University, Chicago, Illinois.
authors.forename: Yi
authors.initials: Y
authors.lastname: Gao
authors.affiliation: Department of Radiology, Northwestern University Feinberg School of Medicine, 676 North St. Clair Street, Ste 800, Chicago, IL 60611.
authors.forename: Albert A
authors.initials: AA
authors.lastname: Nemcek
authors.affiliation: Department of Radiology, Northwestern University Feinberg School of Medicine, 676 North St. Clair Street, Ste 800, Chicago, IL 60611.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Lewandowski
authors.affiliation: Department of Radiology, Northwestern University Feinberg School of Medicine, 676 North St. Clair Street, Ste 800, Chicago, IL 60611.
authors.forename: Riad
authors.initials: R
authors.lastname: Salem
authors.affiliation: Department of Radiology, Northwestern University Feinberg School of Medicine, 676 North St. Clair Street, Ste 800, Chicago, IL 60611.
authors.forename: Kent T
authors.initials: KT
authors.lastname: Sato
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003452:Cryosurgery / Q000379:methods*; D018450:Disease Progression; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000379:methods*; D011183:Postoperative Complications; D011237:Predictive Value of Tests; D015641:Radiography, Interventional; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome