Mayo Adhesive Probability Score: An Accurate Image-based Scoring System to Predict Adherent Perinephric Fat in Partial Nephrectomy
Mayo Adhesive Probability Score: An Accurate Image-based Scoring System to Predict Adherent Perinephric Fat in Partial Nephrectomy
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DOI：
10.1016/j.eururo.2014.08.054
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发表时间：
2014-12-01
期刊：
影响因子：
23.4
通讯作者：
Thiel, David D.
中科院分区：
文献类型：
--
作者：
Davidiuk, Andrew J.;Parker, Alexander S.;Thiel, David D.
背景资料：基于图像的肾脏形态测量评分系统用于预测肾部分切除术（PN）的潜在难度，但它们完全集中在肿瘤特异性因素上，而忽略了可能使PN技术方面复杂化的其他患者特异性因素。粘附性肾周脂肪（APF）是已知的使PN困难的因素之一。目的：开发一种准确的基于图像的肾功能测定评分系统，以预测机器人辅助肾部分切除术（RAPN）期间遇到的APF的存在。设计、设置和参与者：我们前瞻性分析了100例由一名外科医生进行的连续RAPN，并将APF定义为需要进行肾包膜下剥离以分离肾肿瘤，RAPN.结果测量和统计分析：预测APF存在的评分算法是用多变量logistic回归模型开发的，该模型使用前向选择方法，重点是改善受试者工作特征曲线下面积。结果和局限性：30例患者（30%; 95%置信区间，21-40）有APF。单变量分析显示，男性患者发生APF的可能性增加（p < 0.001），体重指数较高（p = 0.003），后肾周脂肪厚度较大（p < 0.001），侧肾周脂肪厚度较大（p < 0.001），肾周脂肪绞窄（p < 0.001）。其中两个变量，后肾周脂肪厚度和绞合，在多变量分析中对APF的预测性最高，因此用于创建风险评分，称为马约粘连概率（MAP），范围为0 - 5，以预测APF的存在。MAP评分为0的患者APF发生率为6%，评分为1的患者APF发生率为16%，评分为2的患者APF发生率为31%，评分为3-4的患者APF发生率为73%，评分为5的患者APF发生率为100%。患者总结：我们开发的马约粘附概率评分是一个准确的系统，可以预测肾周是否存在粘附性或“粘性”脂肪，这将使肾部分切除术变得困难。(C)2014年欧洲泌尿外科协会。Elsevier B. V.出版，保留所有权利。
Background: Image-based renal morphometry scoring systems are used to predict the potential difficulty of partial nephrectomy (PN), but they are centered entirely on tumor-specific factors and neglect other patient-specific factors that may complicate the technical aspects of PN. Adherent perinephric fat (APF) is one such factor known to make PN difficult.Objective: To develop an accurate image-based nephrometry scoring system to predict the presence of APF encountered during robot-assisted partial nephrectomy (RAPN).Design, setting, and participants: We prospectively analyzed 100 consecutive RAPNs performed by one surgeon and defined APF as the need for subcapsular renal dissection to isolate the renal tumor for RAPN.Outcome measurements and statistical analysis: The scoring algorithm to predict the presence of APF was developed with a multivariable logistic regression model using a forward selection approach with a focus on improvement in the area under the receiver operating characteristic curve.Results and limitations: Thirty patients (30%; 95% confidence interval, 21-40) had APF. Single-variable analysis noted an increased likelihood of APF in male patients (p < 0.001), higher body mass index (p = 0.003), greater posterior perinephric fat thickness (p < 0.001), greater lateral perinephric fat thickness (p < 0.001), and those with perirenal fat stranding (p < 0.001). Two of these variables, posterior perinephric fat thickness and stranding, were most highly predictive of APF in multivariable analysis and were therefore used to create a risk score, termed Mayo Adhesive Probability (MAP) and ranging from 0 to 5, to predict the presence of APF. We observed APF in 6% of patients with a MAP score of 0, 16% with a score of 1, 31% with a score of 2, 73% with a score of 3-4, and 100% of patients with a score of 5.Conclusions: MAP score accurately predicts the presence of APF in patients undergoing RAPN. Prospective validation of the MAP score is required.Patient summary: The Mayo Adhesive Probability score that we we developed is an accurate system that predicts whether or not adherent perinephric, or "sticky,'' fat is present around the kidney that would make partial nephrectomy difficult. (C) 2014 European Association of Urology. Published by Elsevier B.V. All rights reserved.