Associations between R.E.N.A.L nephrometry score and survival outcomes in renal tumors

Abstract

Abstract Objective R.E.N.A.L. nephrometry score could be used to predict surgical outcomes and renal tumor aggressiveness. We aimed to analyze its associations with survival outcomes. Materials and methods We included 1368 patients with sporadic, unilateral and non-metastatic renal tumors who received curative nephrectomy in Zhongshan Hospital from January 2009 to September 2019. R.E.N.A.L. nephrometry scores (RNS) were assigned by three urologists based on preoperative CT/MRI scans. Correlations between parameters or sum of RNS, overall survival (OS) and recurrence-free survival (RFS) were analyzed by Kaplan-Meier analyses and multivariate cox regression model. We further compared survival outcomes between patients who received partial nephrectomy and patients who received radical nephrectomy. Results We observed statistically significant associations between all components of RNS and oncologic outcomes, including R (Radius) (OS, p < 0.001; RFS, p < 0.001), E (Exophytic/endophytic) (OS, p = 0.003; RFS, p < 0.001), N (Nearness) (OS, p = 0.063; RFS, p < 0.001), A (Anterior/posterior) (OS, p < 0.001; RFS, p = 0.005), L (Location) (OS, P = 0.008; RFS, p < 0.001) and suffix “h” (OS, p = 0.237; RFS, p = 0.034). Kaplan-Meier curves of OS and RFS rates were significantly different when stratified by RNS complexity group (OS, p < 0.001; RFS, p < 0.001). After adjusting for tumor stage and grade, RNS as continuous variables was an adverse independent risk factor for survival outcomes [p = 0.027, HR (95%CI) = 1.151 (1.016–1.303)] and RFS [p < 0.001, HR(95%CI) = 1.299 (1.125–1.501)]. For tumors with RNS score of 4 and 5, partial nephrectomy showed a survival benefit than radical nephrectomy. Conclusion Both components and complexity groups of R.E.N.A.L. nephrometry score associated with survival outcomes in renal tumor patients.