ABC评分系统在微创肾部分切除术中的外部验证

目的:评估基于动脉的复杂性(arterial based complexity,ABC)评分系统对预测微创肾部分切除术(minimally invasive partialnephrectomy,MIPN)临床相关结果的作用。方法:回顾性分析2016年6月至2018年1月161例于天津医科大学肿瘤医院行MIPN治疗的肾癌患者的临床资料。根据患者术前腹部增强CT图像行ABC评分,分为1、2、3S和3H级。评价ABC评分系统的可重复性,分析ABC评分与患者病理特征、手术相关变量、术后并发症及肾功能的关系。结果:1、2、3S、3H级的患者分别占20.5%( 33/161)、 60.2%( 97/161)、 11.8%( 19/161)、 7.5%( 12/161)。医师评分结果的平均Kappa值为0.523,平均精确匹配百分比为70.2%。ABC评分与手术时间、热缺血时间(warm ischemia time,WIT)、估计失血量(estimated blood loss,EBL)、肿瘤大小有显著性相关(均P<0.001),与术后住院时间、术后并发症、术前估算肾小球滤过率(estimated glomerular filtration rate,eGFR)、术后3个月及6个月的eGFR无显著相关性(均P>0.05)。结论:ABC评分系统具有较好的可重复性,对MIPN的复杂程度具有一定的预测意义,但其临床应用价值仍需进一步深入研究。

External validation of the ABC scoring system in minimally invasive partial nephrectomy

  Objective  To assess the role of the arterial based complexity (ABC) scoring system in predicting clinically relevant outcomes of minimally invasive partial nephrectomy (MIPN).  Methods  A retrospective review of 161 renal cell carcinoma patients who underwent MIPN at Tianjin Medical University Cancer Institute and Hospital from June 2016 to January 2018 was performed. The ABC score, including grades 1, 2, 3S, and 3H, were based on the patients' enhanced preoperative abdominal CT images. The reproducibility of the ABC scoring system was evaluated, and the relationship between the ABC score and patients' pathological features, surgery-related variables, postoperative complications, and renal function was analyzed.  Results  Patients in grades 1, 2, 3S, and 3H in this study accounted for 20.5% (33/161), 60.2% (97/161), 11.8% (19/161), and 7.5% (12/161), respectively. The average Kappa value of the physician's score was 0.523, and the average exact match percentage was 70.2%. The ABC score was significantly associated with operative time, warm ischemia time (WIT), estimated blood loss (EBL), and tumor size (P < 0.001 for all) and was not associated with postoperative hospital stay, postoperative complications, preoperative estimated glomerular filtration rate (eGFR), and eGFR at 3 and 6 months postoperatively (P>0.05 for both).  Conclusions  The ABC score is a scoring system with good repeatability and has certain predictive significance for the complexity of MIPN. However, further research is needed for its clinical application.