Our objective was to develop a new, simple, and ablation-specific nephrometry score to predict peri-operative outcomes and to compare its predictive accuracy to PADUA and RENAL scores. Overall, 418 patients were treated with percutaneous thermal ablation (microwave and radiofrequency) between 2008 and 2021. The outcome of interest was trifecta status (achieved vs. not achieved): incomplete ablation or Clavien-Dindo ≥ 3 complications or postoperative estimated glomerular filtration rate decrease ≥ 30%. First, we validated the discrimination ability of the PADUA and RENAL scoring systems. Second, we created and internally validated a novel scoring (SuNS) system, according to multivariable logistic regression models. The predictive accuracy of the model was tested in terms of discrimination and calibration. Overall, 89 (21%) patients did not achieve trifecta. PADUA and RENAL scores showed poor ability to predict trifecta status (c-indexes 0.60 [0.53-0.67] and 0.62 [0.55-0.69], respectively). We, therefore, developed the SuNS model (c-index: 0.74 [0.67-0.79]) based on: (1) contact surface area; (2) nearness to renal sinus or urinary collecting system; (3) tumour diameter. Three complexity classes were created: low (3-4 points; 11% of no trifecta) vs. moderate (5-6 points; 30% of no trifecta) vs. high (7-8 points; 65% of no trifecta) complexity. Limitations include the retrospective and single-institution nature of the study. In conclusion, we developed an immediate, simple, and reproducible ablation-specific nephrometry score (SuNS) that outperformed PADUA and RENAL nephrometry scores in predicting peri-operative outcomes. External validation is required before daily practice implementation.
Diagnostics (Basel, Switzerland). 2023 Sep 15*** epublish ***
Gennaro Musi, Stefano Luzzago, Giovanni Mauri, Francesco Alessandro Mistretta, Gianluca Maria Varano, Chiara Vaccaro, Sonia Guzzo, Daniele Maiettini, Ettore Di Trapani, Paolo Della Vigna, Roberto Bianchi, Guido Bonomo, Matteo Ferro, Zhe Tian, Pierre I Karakiewicz, Ottavio de Cobelli, Franco Orsi, Mattia Luca Piccinelli
Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy., Department of Oncology and Haemato-Oncology, Università degli Studi di Milano, 20122 Milan, Italy., Division of Interventional Radiology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy., Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC H2X3E4, Canada.