Cancer - Kidney(구연) (E-090)
부분신절제술 환자에서 perioperative outcome의 예측인자로서 RENAL nephrometry 중 N 점수의 유용성
서울대학교 의과대학 비뇨의학과
박대형, 유상현, 윤현식, 정규환, 윤지환, 서준고, 육형동, 정창욱, 구자현, 김현회, 곽 철
PURPOSE
RENAL nephrometry score (RNS) has been reported to be a useful predictor of intraoperative and postoperative results of partial nephrectomy. However, the role of each factor has not been well clarified. Thus we evaluated the impact of each factor of RNS in predicting intraoperative and postoperative outcomes of partial nephrectomy.

METHODS
We selected patients from a prospective cohort, the Seoul National University Prospectively Enrolled Registry for Renal Cell Carcinoma – Nephrectomy (SUPER-RCC-Nx). We analyzed the data of 405 patients who underwent partial nephrectomy from March 2016 until March 2019. Each factor of RNS was analyzed by using logistic regression analysis to predict (1) warm ischemic time (WIT) > 20 minutes, (2) severe postoperative complications (Gr III or higher) within 90 days, or (3) estimated glomerular filtration rate (eGFR) decrease more than 10% after one year.

RESULTS
The median age was 61 (IQR 52-69) years. According to the RNS, 246 patients (60.7%) had low complexity (4-6) and 159 patients (39.3%) had moderate to high complexity scores (7-12). Regarding operative outcomes, 126 patients (31.1%) had WIT > 2 0 minutes, 70 patients (17.3%) had any grade postoperative complications of which 17 (4.2%) had severe complication, and 168 cases (41.5%) showed decreased eGFR more than 10% after 1 year.
In multivariable analysis, patients with 3 points in N showed higher risk of WIT >20 minutes (OR 3.28, 95% CI: 1.84-5.85), severe complication (OR 2.99, 95% CI: 1.03-8.67), and >10% eGFR decrease after 1 year (OR 1.69, 95% CI: 1.08-2.66) compared with patients with 1 point in N, respectively.

CONCLUSION
N score is a meaningful predictor for a longer warm ischemic time, the severe postoperative complications, and postoperative renal function decrease in patients undergoing partial nephrectomy.
keywords : nephrometry, RENAL score, partial nephrectomy

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