ORIGINAL ARTICLE   Free access

Minerva Urology and Nephrology 2023 October;75(5):569-76

DOI: 10.23736/S2724-6051.23.05324-7

Copyright © 2023 EDIZIONI MINERVA MEDICA

language: English

Can Simplified PADUA Renal (SPARE) Nephrometry scoring system help predict renal function outcomes after robot-assisted partial nephrectomy? (UroCCR study 93)

Clément KLEIN ¹ ✉, Gaelle MARGUE ¹, Cécile CHAMPY ², Bastien PARIER ³, Thibaut WAECKEL ⁴, Karim BENSALAH ⁵, Jonathan OLIVIER ⁶, Nicolas DOUMERC ^{7, 8}, François AUDENET ⁹, Nicolas BRANGER ¹⁰, Morgan ROUPRET ^{8, 11}, Louis SURLEMONT ¹², Franck BRUYERE ¹³, Xavier DURAND ¹⁴, Mathieu DURAND ¹⁵, Jean-Alexandre LONG ¹⁶, Victor GAILLARD ¹⁷, Evanguelos XYLINAS ¹⁸, Maxime VALLEE ¹⁹, Benjamin ROUGET ²⁰, Pierre BIGOT ^{8, 21}, Jean-Christophe BERNHARD ^{1, 8}

¹ Department of Urology, University Hospital of Bordeaux, Bordeaux, France; ² Department of Urology, Henri Mondor Hospital, Paris, France; ³ Department of Urology, Kremlin Bicêtre Hospital, Paris, France; ⁴ Department of Urology, Caen University Hospital, Caen, France; ⁵ Department of Urology, University Hospital of Rennes, Rennes, France; ⁶ Department of Urology, University Hospital of Lille, Lille, France; ⁷ Department of Urology, University Hospital of Toulouse, Toulouse, France; ⁸ Comité de Cancérologie de l’Association Française d’Urologie (CCAFU), Groupe Rein, Paris, France; ⁹ Department of Urology, European Georges Pompidou Hospital, Paris, France; ¹⁰ Department of Urology, Paoli Calmettes Institute, Marseille, France; ¹¹ Department of Urology, La Pitié Salpêtrière Hospital, Paris, France; ¹² Department of Urology, University Hospital of Rouen, Rouen, France; ¹³ Department of Urology, University Hospital of Tours, Tours, France; ¹⁴ Department of Urology, Saint Joseph Hospital, Paris, France; ¹⁵ Department of Urology, University Hospital of Nice, Nice, France; ¹⁶ Department of Urology, University Hospital of Grenoble, Grenoble, France; ¹⁷ Department of Urology, University Hospital of Strasbourg, Strasbourg, France; ¹⁸ Department of Urology, Bichat Hospital, Paris, France; ¹⁹ Department of Urology, University Hospital of Poitiers, Poitiers, France; ²⁰ Department of Urology, Hospital of Libourne, Libourne, France; ²¹ Department of Urology, University Hospital of Angers, Angers, France

BACKGROUND: The SPARE Nephrometry Score (NS) is described as easier to implement than the RENAL and PADUA NSs, currently more widely used. Our objective was to compare the accuracy of SPARE NS in predicting renal function outcomes following RAPN.
METHODS: A multicentric retrospective study was conducted using French kidney cancer network (UroCCR, NCT 03293563) database. All patients included had RAPN for cT1 renal tumors between May 2010 and March 2021. SPARE was compared to RENAL, PADUA and Tumor Size to predict postoperative acute kidney injury (AKI), chronic kidney disease (CKD) upstaging, de novo CKD at 3-6 months follow-up and Trifecta failure. The ability of the different NSs and tumor size to predict renal function outcomes was evaluated using uni- and multivariate logistic regression models.
RESULTS: According to our study criteria, 1171 patients were included. Mean preoperative tumor size and estimated glomerular filtration rate (eGFR) were 3.4±1.4 cm and 85.8 mL/min/1.73 m². In total, 266 (22.7%), 87 (7.4%), 94 (8%), and 624 (53.3%) patients had AKI, de novo CKD, CKD upstaging, and Trifecta failure, respectively. In multivariate analysis, all three NSs and tumor size were independent predictors of AKI, CKD de novo, CKD upgrade and Trifecta failure. There was no significant difference between all three NS and tumor sizes in predicting renal function outcomes.
CONCLUSIONS: SPARE Score seems to be a valid alternative to predict renal function outcomes after RAPN. Nevertheless, in our study, tumor size was as accurate as NSs in predicting postoperative outcomes and, therefore, seems to be the logical choice for surgical decisions.

KEY WORDS: Robotic surgical procedures; Nephrectomy; Kidney disease; Kidney neoplasms; Organ dysfunction scores