Comparing the Predictive Values of Diameter-Axial-Polar and Renal Scores for Long-Term Trifecta Outcomes in Robot-Assisted Partial Nephrectomy for Renal Cell Carcinoma

摘要

Purpose: Few studies have reported the value of the diameter-axial-polar (DAP) score in robot-assisted partial nephrectomy (RaPN) for renal cell carcinoma (RCC) and sequentially compare DAP and RENAL nephrometry score to predict long-term surgical, oncological, and functional outcomes of RaPN for renal cancer. This study demonstrated that the DAP score is effective enough to predict long-term trifecta outcomes of RaPN. Materials and Methods: We retrospectively collected clinical data of 108 patients with pathologically confirmed RCC who received RaPN by a single surgeon during 2012–2017. The patients were stratified into low, intermediate, and high complexities according to the RENAL and DAP scoring systems. We analyzed warm ischemia time (WIT), cancer-specific survival, radiographic progression-free survival, positive rate of surgical margin, renal function from the preoperative period to postoperative 1 st /6 th month, and postoperative complications. Results: The median follow-up period was 36 months. The 3-year cancer-specific survival rate and 3-year radiographic progression-free survival were 98.4% and 95.2%, respectively. Four patients (3.6%) had positive surgical margins. The largest decrease of renal functions from pre- to postoperative 6 th month was noted in the intermediate DAP score group. No difference was observed between the DAP and RENAL scores in terms of WIT in 25 min, positive margin, complication, 3-year radiographic local recurrence, and chronic kidney disease (CKD) change, but a significant difference was observed in WIT in 20 min (area under the curve of DAP vs. RENAL = 0.81 vs. 0.54, P = 0.03). Age is an independent factor for progression to CKD after RaPN (odds ratio = 1.054, 95% confidence interval = 1.008–1.102, P = 0.022). Complications occurred in 22 patients (20.4%), and the most common postoperative complications were bleeding (12.2%), postoperative fever (0.5%), and urinary leakage (0.3%). Conclusion: The DAP score is an easy and effective tool for predicting perioperative outcomes of RaPN, especially in WIT in 20 min.