Construction and application of a three-dimensional vascular variation-based nephrometry scoring system for completely endophytic renal tumors  

作　　者：Aihetaimujiang Anwaier Xiangxian Che Lei Shi Xi Tian Shiqi Ye Wenhao Xu Yu Zhu Hailiang Zhang Dingwei Ye 

机构地区：[1]Department of Urology,Fudan University Shanghai Cancer Center,Shanghai,China [2]Shanghai Genitourinary Cancer Institute,Shanghai,China [3]Department of Oncology,Fudan University Shanghai Medical College,Shanghai,China [4]Department of Operating Room,Fudan University Shanghai Cancer Center,Shanghai,China

出　　处：《Journal of the National Cancer Center》2024年第4期346-353,共8页癌症科学进展（英文）

基　　金：We thank researchers for patients enrolled from the FUSCC cohort.This work was supported by grants from the National Natural Science Foundation of China(grant numbers:81802525 and no.82172817);the Natural Science Foundation of Shanghai(grant number:20ZR1413100);Beijing Xisike Clinical Oncology Research Foundation(grant number:Y-HR2020MS-0948);the Shanghai“Science and Technology Innova-tion Action Plan”medical innovation research Project(grant num-ber:22Y11905100);the Shanghai Anti-Cancer Association Eyas Project(grant number:SACA-CY21A06 and no.SACA-CY21B01);Fudan University Fuqing scholars Project(grant number:FQXZ202304A).

摘　　要：Background:Completely endophytic renal tumors(CERT)pose significant challenges due to their anatomical complexity and loss of visual clues about tumor location.A facile scoring model based on three-dimensional(3D)reconstructed images will assist in better assessing tumor location and vascular variations.Methods:In this retrospective study,80 patients diagnosed with CERT were included.Forty cases underwent preoperative assessment using 3D reconstructed imaging(3D-Cohort),while the remaining 40 cases were assessed using two-dimensional imaging(2D-Cohort).Vascular variations were evaluated by ascertaining the presence of renal arteries>1,prehilar branching arteries,and arteries anterior to veins.The proposed scoring system,termed RAL,encompassed three critical components:(R)adius(maximal tumor diameter in cm),(A)rtery(occurrence of arterial variations),and(L)ocation relative to the polar line.Comparison of the RAL scoring system was made with established nephrometry scoring systems.Results:A total of 48(60%)patients exhibited at least one vascular variation.In the 2D-Cohort,patients with vascular variations experienced significantly prolonged operation time,increased bleeding volume,and extended warm ischemia time compared with those without vascular variations.Conversely,the presence of vascular vari-ations did not significantly affect operative parameters in the 3D-Cohort.Furthermore,the 2D-Cohort demon-strated a notable decline in both short-and long-term estimated glomerular filtration rate(eGFR)changes com-pared with the 3D-Cohort,a trend consistent across patients with warm ischemia time≥25 min and those with vascular variations.Notably,the 2D-Cohort exhibited a larger margin of normal renal tissue compared with the 3D-Cohort.Elevated RAL scores correlated with larger tumor size,prolonged operation time,extended warm is-chemia time,and substantial postoperative eGFR decrease.The RAL scoring system displayed superior predictive capabilities in assessing postoperative eGFR changes compared with conventional ne

关 键 词：Completely endophytic renal tumors Three-dimensional reconstructed images Vascular variation Nephrometry scoring system Robot-assistant partial nephrectomy Renal function 

分 类 号：R73[医药卫生—肿瘤]