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Böbrek Tümör Skorlama Sistemleri Tümör Agresivitesini Tahmin Edebilir Mi?

Year 2023, Volume: 18 Issue: 3, 249 - 257, 25.10.2023

Arif Özkan , Nusret Çilesiz , Arif Kalkanlı , Cem Tuğrul Gezmiş , Memduh Aydın

https://doi.org/10.33719/yud.2023-18-3-1355748

Abstract

Amaç: Bu çalışmanın amacı, T1 böbrek tümörlerinde R.E.N.A.L. nefrometri skoru (RNS), Padua skoru (PS), C-indeks ile tümör agresivitesi arasındaki ilişkiyi incelemek ve bu skorlama sistemlerinin, tümörün anatomisine ek olarak patolojisi hakkında klinik değerlendirmeyi yönlendirmek için bilgi sağlayıp sağlamadığını sorgulamaktır.
Gereç ve Yöntemler: Preoperatif klinik evrelendirmeye göre evre 1 (T1N0M0) 83 berrak hücreli renal hücreli karsinom (cRCC) hastası değerlendirildi. Patolojik sonuçlarına göre hastalar iki gruba ayrıldı: Fuhrman derecesi 1 veya 2 (FG1-2) olan hastalar (Non-agresif grup (NAG)) ve FG3-4 ve/veya TNM Evre 3 olan hastalar (Agresif grup (AG)). Her hastanın RNS, PS ve C-indeks puanları hesaplandı. Son olarak, nefrometri skorları ile patolojik agresivite arasındaki ilişki karşılaştırıldı.
Bulgular: Ortalama RNS, 7.3±2.4 olarak hesaplandı. Toplam RNS, AG’de (9.2±1.2) NAG’den (6±2.2) anlamlı derecede yüksekti (p<0.001). RNS, patolojik agresif hastalığın bağımsız bir öngörücüsüydü (p<0.001). En yüksek eğri altı alan için RNS’ nin eşik değeri 8 olarak bulundu (p<0.001). Ortalama PS, 8.1±1.6 olarak hesaplandı. PS ayrıca patolojik agresif hastalığın bağımsız bir öngörücüsüydü (p<0.001). En yüksek eğri altı alan için PS’nin eşik değeri 8 olarak bulundu (p<0.001). AG›nin ortalama C-indeks puanı (1.4 ± 0.4), NAG› den (2.7±2.0) anlamlı derecede düşüktü (p<0.001). C-indeks, patolojik agresiviteyi tahmin etmede anlamlıdır (p<0.001).
Sonuçlar: Daha yüksek RNS ve PS puanları ile düşük C-indeks puanlarının böbrek tümörlerinin tümör agresivitesi ile ilişkilendirildiğini sonucuna varılmıştır.

Keywords

Padua C-endeksi R.E.N.A.L. nefrometri tümör agresivitesi Fuhrman Derecesi. Böbrek hücreli karsinom

References

  • 1. Israel GM , Silverman SG . The incidental renal mass . Radiol Clin North Am. 2011;49:369-83. https://doi.org/10.1016/j.rcl.2010.10.007.
  • 2. Parsons JK, Schoenberg MS, Carter HB. Incidental renal tumors:casting doubt on the efficacy of early intervention. Urology. 2001;57:1013-5. https://doi.org/10.1016/s0090-4295(01)00991-8.
  • 3. Russo P, Jang TL, Pettus JA et al. Survival rates after resection for localized kidney cancer: 1989 to 2004. Cancer. 2008 Jul 1;113(1):84-96. https://doi.org/10.1002/cncr.23520.
  • 4. Campbell SC, Novick AC, Belldegrun A et al; Practice Guidelines Committee of the American Urological Association. Guideline for management of the clinical T1 renal mass. J Urol. 2009;182(4):1271-9. https://doi.org/10.1016/j.juro.2009.07.004.
  • 5. Frank I, Blute ML, Cheville JC et al. Solid renal tumors: an analysis of pathological features related to tumor size. J Urol. 2003;170(6Pt1):2217-20. https://doi.org/10.1097/01.ju.0000095475.12515.5e. 
  • 6. Lane BR, Samplaski MK, Herts BR et al. Renal mass biopsy--a renaissance? J Urol. 2008;179(1):20-7. https://doi.org/10.1016/j.juro.2007.08.124. 
  • 7. Jeldres C, Sun M, Liberman D et al. Can renal mass biopsy assessment of tumor grade be safely substituted for by a predictive model? J Urol. 2009;182(6):2585-9. https://doi.org/10.1016/j.juro.2009.08.053.
  • 8. Lane BR, Babineau D, Kattan MW et al. A preoperative prognostic nomogram for solid enhancing renal tumors 7 cm or less amenable to partial nephrectomy. J Urol. 2007;178(2):429-34. https://doi.org/10.1016/j.juro.2007.03.106. 
  • 9. Weizer AZ, Gilbert SM, Roberts WW. Tailoring technique of laparoscopic partial nephrectomy to tumor characteristics. J Urol. 2008;180(4):1273-8. https://doi.org/10.1016/j.juro.2008.06.066.
  • 10. Schachter LR, Bach AM, Snyder ME. The impact of tumour location on the histological subtype of renal cortical tumours. BJU Int. 2006;98(1):63-6. https://doi.org/10.1111/j.1464-410X.2006.06179.x.
  • 11. Venkatesh R, Weld K, Ames CD et al. Laparoscopic partial nephrectomy for renal masses: effect of tumor location. Urology. 2006;67(6):1169-74. https://doi.org/10.1016/j.urology.2006.01.089. 
  • 12. Kutikov A, Uzzo RG. The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth. J Urol. 2009;182:844-53. https://doi.org/10.1016/j.juro.2009.05.035.
  • 13. Ficarra V, Novara G, Secco S et al. Preoperative aspects and dimensions used for an anatomical (PADUA) classification of renal tumours in patients who are candidates for nephron-sparing surgery. Eur Urol. 2009;56(5):786-93. https://doi.org/10.1016/j.eururo.2009.07.040.
  • 14. Simmons MN, Ching CB, Samplaski MK et al. Kidney tumor location measurement using the C index method. J Urol. 2010;183(5):1708-13. https://doi.org/10.1016/j.juro.2010.01.005.
  • 15. Uzzo RG. Renalmasses--to treat or not to treat? If that is the question are contemporary biomarkers the answer? J Urol. 2008;180:433-4. https://doi.org/10.1016/j.juro.2008.04.124.
  • 16. Choudhary S, Rajesh A, Mayer NJ et al. Renal oncocytoma: CT features cannot reliably distinguish oncocytoma from other renal neoplasms. Clin Radiol. 2009;64:517. https://doi.org/10.1016/j.crad.2008.12.011.
  • 17. Hollingsworth JM, Miller DC, Daignault S, et al. Rising incidence of small renal masses: a need to reassess treatment effect. J Natl Cancer Inst. 2006; 98:1331-4. https://doi.org/10.1093/jnci/djj362.
  • 18. Kunkle DA, Egleston BL, Uzzo RG. Excise, ablate or observe: the small renal mass dilemma - a meta-analysis and review. J Urol. 2008;179:1227-34. https://doi.org/10.1016/j.juro.2007.11.047. 
  • 19. Kutikov A, Smaldone MC, Egleston BL, et al. Anatomic features of enhancing renal masses predict malignant and high-grade pathology: a preoperative nomogram using the R.E.N.A.L. nephrometry score. Eur Urol. 2011;60:241-8. https://doi.org/10.1016/j.eururo.2011.03.029. 
  • 20. Wang HK, Zhu Y, Yao XD, et al. External validation of a nomogram using R.E.N. A.L. nephrometry score to predict high grade renal cell carcinoma. J Urol. 2012;187:1555-60. https://doi.org/10.1016/j.juro.2011.12.099.
  • 21. Bagrodia A, Harrow B, Liu ZW, et al. Evaluation of anatomic and morphologic nomogram to predict malignant and high-grade disease in a cohort of patients with small renal masses. Urol Oncol. 2014;32:37.e17-23. https://doi.org/10.1016/j.urolonc.2013.03.003. 
  • 22. Koo CK, Yoo H, Shin TY, et al. External validation of the R.E.N.A.L. nephrometry score nomogram for predicting high-grade renal cell carcinoma in solid, enhancing, and small renal masses. World J Urol. 2014;32:249-55. https://doi.org/10.1007/s00345-013-1159-3. 
  • 23. Antonelli A, Furlan M, Sandri M, et al. The R.E.N.A.L. nephrometric nomogram cannot accurately predict malignancy or aggressiveness of small renal masses amenable to partial nephrectomy. Clin Genitourin Cancer. 2014;12(5):366-72. https://doi.org/10.1016/j.clgc.2014.02.003.
  • 24. Mullins JK, Kaouk JH, Bhayani S, et al. Tumor complexity predicts malignant disease for small renal masses. J Urol. 2012;188:2072-2076. https://doi.org/10.1016/j.juro.2012.08.027. 
  • 25. Srigley JR, Delahunt B, Eble JN et al; ISUP Renal Tumor Panel. The International Society of Urological Pathology (ISUP) Vancouver Classification of Renal Neoplasia. Am J Surg Pathol. 2013;37(10):1469-89. https://doi.org/10.1097/PAS.0b013e318299f2d1.
  • 26. Cho HJ, Kim SJ, Ha US et al. Prognostic value of capsular invasion for localized clear-cell renal cell carcinoma. Eur Urol. 2009;56(6):1006-12. https://doi.org/10.1016/j.eururo.2008.11.031.
  • 27. Song B, Hwang SI, Lee HJ, Lee H, Oh JJ, Lee S, Hong SK, Byun SS, Kim JK. Computer tomography-based shape of tumor contour and texture of tumor heterogeneity are independent prognostic indicators for clinical T1b-T2 renal cell carcinoma. World J Urol. 2023 Aug 2. doi: 10.1007/s00345-023-04543-4. 
  • 28. Chen SH, Wu YP, Li XD, et al. R.E.N.A.L. Nephrometry Score: A Preoperative Risk Factor Predicting the Fuhrman Grade of Clear-Cell Renal Carcinoma. J Cancer. 2017 Oct 17;8(18):3725-3732. https://doi.org/10.7150/jca.21189.
  • 29. Shim M, Song C, Park S, Kim A, Choi SK, Kim CS, et al. Hilar location is an independent prognostic factor for recurrence in T1 renal cell carcinoma after nephrectomy. Ann Surg Oncol. 2015;22: 344-50. https://doi.org/10.1245/s10434-014-4153-0.
  • 30. Przydacz M, Golabek T, Okon K, Dudek P, Chlosta P. Prognostic effect of renal collecting system invasion on survival of patients with renal cell carcinoma and tumor thrombus. Cent European J Urol. 2020;73(3):280-286. doi: 10.5173/ceju.2020.0172.

Could Renal Tumour Scoring Systems Predict Tumour Aggressivity?

Year 2023, Volume: 18 Issue: 3, 249 - 257, 25.10.2023

Arif Özkan , Nusret Çilesiz , Arif Kalkanlı , Cem Tuğrul Gezmiş , Memduh Aydın

https://doi.org/10.33719/yud.2023-18-3-1355748

Abstract

Objective: The aim of this study is to investigate the relationship between R.E.N.A.L. nephrometry score (RNS), Padua score (PS), Centrality (C)-index and tumour aggressivity in T1 renal tumours and to question whether these scoring systems would provide information about the pathology of renal tumours to manage clinical judgement rather than the anatomy of tumour.
Material and Methods: We evaluated 83 patients with stage 1 (T1N0M0) clear cell renal cell carcinoma (cRCC) according to preoperative radiological and pathological staging. Patients were divided according to pathological results of cRCC into two groups: Patients with Fuhrman grade 1 or 2 (FG1-2) (Non-aggresive group (NAG)) and patients with FG3-4 and/or TNM Stage 3 (Aggressive group (AG)). RNS, PS and C-index scores were calculated for each patient. Finally,the relationship between nephrometry scores and pathological aggressivity were compared.
Results: The mean RNS was calculated as 7.3±2.4. Total RNS was significantly higher in AG (9.2±1.2) than in NAG (6±2.2) (p<0.001). RNS was an independent predictor of pathological aggressive disease (p<0.001). The cut off value of RNS at the highest area under curve was 8 (p<0.001). The mean PS was calculated as 8.1±1.6. PS was also an independent predictor of pathological aggressive disease (p<0.001). The cut off value of PS at the highest area under curve was 8 (p<0.001). The mean C-index score of AG (1.4 ± 0.4) was significantly lower (p<0.001) than NAG (2.7±2.0). C-index is significant in predicting pathological aggressiveness (p<0.001).
Conclusions: Our results suggested that higher RNS and PS scores, lower C-index scores were associated with tumour aggressivity of renal tumours.

Keywords

Renal cell carcinoma Padua C-index R.E.N.A.L. nephrometry tumour aggressivity Fuhrman Grade

Ethical Statement

Our study was approved by Taksim Education Hospital Ethical Committee (No:23/23.03.2016).

References

  • 1. Israel GM , Silverman SG . The incidental renal mass . Radiol Clin North Am. 2011;49:369-83. https://doi.org/10.1016/j.rcl.2010.10.007.
  • 2. Parsons JK, Schoenberg MS, Carter HB. Incidental renal tumors:casting doubt on the efficacy of early intervention. Urology. 2001;57:1013-5. https://doi.org/10.1016/s0090-4295(01)00991-8.
  • 3. Russo P, Jang TL, Pettus JA et al. Survival rates after resection for localized kidney cancer: 1989 to 2004. Cancer. 2008 Jul 1;113(1):84-96. https://doi.org/10.1002/cncr.23520.
  • 4. Campbell SC, Novick AC, Belldegrun A et al; Practice Guidelines Committee of the American Urological Association. Guideline for management of the clinical T1 renal mass. J Urol. 2009;182(4):1271-9. https://doi.org/10.1016/j.juro.2009.07.004.
  • 5. Frank I, Blute ML, Cheville JC et al. Solid renal tumors: an analysis of pathological features related to tumor size. J Urol. 2003;170(6Pt1):2217-20. https://doi.org/10.1097/01.ju.0000095475.12515.5e. 
  • 6. Lane BR, Samplaski MK, Herts BR et al. Renal mass biopsy--a renaissance? J Urol. 2008;179(1):20-7. https://doi.org/10.1016/j.juro.2007.08.124. 
  • 7. Jeldres C, Sun M, Liberman D et al. Can renal mass biopsy assessment of tumor grade be safely substituted for by a predictive model? J Urol. 2009;182(6):2585-9. https://doi.org/10.1016/j.juro.2009.08.053.
  • 8. Lane BR, Babineau D, Kattan MW et al. A preoperative prognostic nomogram for solid enhancing renal tumors 7 cm or less amenable to partial nephrectomy. J Urol. 2007;178(2):429-34. https://doi.org/10.1016/j.juro.2007.03.106. 
  • 9. Weizer AZ, Gilbert SM, Roberts WW. Tailoring technique of laparoscopic partial nephrectomy to tumor characteristics. J Urol. 2008;180(4):1273-8. https://doi.org/10.1016/j.juro.2008.06.066.
  • 10. Schachter LR, Bach AM, Snyder ME. The impact of tumour location on the histological subtype of renal cortical tumours. BJU Int. 2006;98(1):63-6. https://doi.org/10.1111/j.1464-410X.2006.06179.x.
  • 11. Venkatesh R, Weld K, Ames CD et al. Laparoscopic partial nephrectomy for renal masses: effect of tumor location. Urology. 2006;67(6):1169-74. https://doi.org/10.1016/j.urology.2006.01.089. 
  • 12. Kutikov A, Uzzo RG. The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth. J Urol. 2009;182:844-53. https://doi.org/10.1016/j.juro.2009.05.035.
  • 13. Ficarra V, Novara G, Secco S et al. Preoperative aspects and dimensions used for an anatomical (PADUA) classification of renal tumours in patients who are candidates for nephron-sparing surgery. Eur Urol. 2009;56(5):786-93. https://doi.org/10.1016/j.eururo.2009.07.040.
  • 14. Simmons MN, Ching CB, Samplaski MK et al. Kidney tumor location measurement using the C index method. J Urol. 2010;183(5):1708-13. https://doi.org/10.1016/j.juro.2010.01.005.
  • 15. Uzzo RG. Renalmasses--to treat or not to treat? If that is the question are contemporary biomarkers the answer? J Urol. 2008;180:433-4. https://doi.org/10.1016/j.juro.2008.04.124.
  • 16. Choudhary S, Rajesh A, Mayer NJ et al. Renal oncocytoma: CT features cannot reliably distinguish oncocytoma from other renal neoplasms. Clin Radiol. 2009;64:517. https://doi.org/10.1016/j.crad.2008.12.011.
  • 17. Hollingsworth JM, Miller DC, Daignault S, et al. Rising incidence of small renal masses: a need to reassess treatment effect. J Natl Cancer Inst. 2006; 98:1331-4. https://doi.org/10.1093/jnci/djj362.
  • 18. Kunkle DA, Egleston BL, Uzzo RG. Excise, ablate or observe: the small renal mass dilemma - a meta-analysis and review. J Urol. 2008;179:1227-34. https://doi.org/10.1016/j.juro.2007.11.047. 
  • 19. Kutikov A, Smaldone MC, Egleston BL, et al. Anatomic features of enhancing renal masses predict malignant and high-grade pathology: a preoperative nomogram using the R.E.N.A.L. nephrometry score. Eur Urol. 2011;60:241-8. https://doi.org/10.1016/j.eururo.2011.03.029. 
  • 20. Wang HK, Zhu Y, Yao XD, et al. External validation of a nomogram using R.E.N. A.L. nephrometry score to predict high grade renal cell carcinoma. J Urol. 2012;187:1555-60. https://doi.org/10.1016/j.juro.2011.12.099.
  • 21. Bagrodia A, Harrow B, Liu ZW, et al. Evaluation of anatomic and morphologic nomogram to predict malignant and high-grade disease in a cohort of patients with small renal masses. Urol Oncol. 2014;32:37.e17-23. https://doi.org/10.1016/j.urolonc.2013.03.003. 
  • 22. Koo CK, Yoo H, Shin TY, et al. External validation of the R.E.N.A.L. nephrometry score nomogram for predicting high-grade renal cell carcinoma in solid, enhancing, and small renal masses. World J Urol. 2014;32:249-55. https://doi.org/10.1007/s00345-013-1159-3. 
  • 23. Antonelli A, Furlan M, Sandri M, et al. The R.E.N.A.L. nephrometric nomogram cannot accurately predict malignancy or aggressiveness of small renal masses amenable to partial nephrectomy. Clin Genitourin Cancer. 2014;12(5):366-72. https://doi.org/10.1016/j.clgc.2014.02.003.
  • 24. Mullins JK, Kaouk JH, Bhayani S, et al. Tumor complexity predicts malignant disease for small renal masses. J Urol. 2012;188:2072-2076. https://doi.org/10.1016/j.juro.2012.08.027. 
  • 25. Srigley JR, Delahunt B, Eble JN et al; ISUP Renal Tumor Panel. The International Society of Urological Pathology (ISUP) Vancouver Classification of Renal Neoplasia. Am J Surg Pathol. 2013;37(10):1469-89. https://doi.org/10.1097/PAS.0b013e318299f2d1.
  • 26. Cho HJ, Kim SJ, Ha US et al. Prognostic value of capsular invasion for localized clear-cell renal cell carcinoma. Eur Urol. 2009;56(6):1006-12. https://doi.org/10.1016/j.eururo.2008.11.031.
  • 27. Song B, Hwang SI, Lee HJ, Lee H, Oh JJ, Lee S, Hong SK, Byun SS, Kim JK. Computer tomography-based shape of tumor contour and texture of tumor heterogeneity are independent prognostic indicators for clinical T1b-T2 renal cell carcinoma. World J Urol. 2023 Aug 2. doi: 10.1007/s00345-023-04543-4. 
  • 28. Chen SH, Wu YP, Li XD, et al. R.E.N.A.L. Nephrometry Score: A Preoperative Risk Factor Predicting the Fuhrman Grade of Clear-Cell Renal Carcinoma. J Cancer. 2017 Oct 17;8(18):3725-3732. https://doi.org/10.7150/jca.21189.
  • 29. Shim M, Song C, Park S, Kim A, Choi SK, Kim CS, et al. Hilar location is an independent prognostic factor for recurrence in T1 renal cell carcinoma after nephrectomy. Ann Surg Oncol. 2015;22: 344-50. https://doi.org/10.1245/s10434-014-4153-0.
  • 30. Przydacz M, Golabek T, Okon K, Dudek P, Chlosta P. Prognostic effect of renal collecting system invasion on survival of patients with renal cell carcinoma and tumor thrombus. Cent European J Urol. 2020;73(3):280-286. doi: 10.5173/ceju.2020.0172.
There are 30 citations in total.

Details

Primary Language English
Subjects Urology
Journal Section Original Research
Authors

Arif Özkan 0000-0001-6534-5403

Nusret Çilesiz 0000-0003-2115-698X

Arif Kalkanlı 0000-0001-6509-4720

Cem Tuğrul Gezmiş 0000-0002-1634-4516

Memduh Aydın 0000-0002-5851-8246

Publication Date October 25, 2023
Published in Issue Year 2023 Volume: 18 Issue: 3

Cite

Vancouver Özkan A, Çilesiz N, Kalkanlı A, Gezmiş CT, Aydın M. Could Renal Tumour Scoring Systems Predict Tumour Aggressivity? New J Urol. 2023;18(3):249-57.
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