Böbrek Tümör Skorlama Sistemleri Tümör Agresivitesini Tahmin Edebilir Mi?

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

Could Renal Tumour Scoring Systems Predict Tumour Aggressivity?

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

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