PKUTHLP score: A comprehensive system to predict surgical approach in radical nephrectomy and thrombectomy

Zhao,Xun; Liu,Zhuo; Zhang,Hongxian; Li,Liwei; Tang,Shiying; Wang,Guoliang; Zhang,Shudong; Wang,Shumin; Tian,Xiaojun; Ma,Lulin

doi:10.3892/ol.2020.11571

PKUTHLP score: A comprehensive system to predict surgical approach in radical nephrectomy and thrombectomy

Authors:
- Xun Zhao
- Zhuo Liu
- Hongxian Zhang
- Liwei Li
- Shiying Tang
- Guoliang Wang
- Shudong Zhang
- Shumin Wang
- Xiaojun Tian
- Lulin Ma
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Affiliations: Department of Urology, Peking University Third Hospital, Beijing 100191, P.R. China, Department of Ultrasound, Peking University Third Hospital, Beijing 100191, P.R. China
Published online on: April 23, 2020 https://doi.org/10.3892/ol.2020.11571
Pages: 201-208
Copyright: © Zhao et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

The present study aimed to develop an accurate preoperative scoring system to predict the probability of using laparoscopic surgery in radical nephrectomy and thrombectomy. The clinical data of 123 patients with renal cell carcinoma with renal vein or inferior vena cava tumour thrombus admitted to the Department of Urology at Peking University Third Hospital between January 2015 and May 2018 were retrospectively analysed. Univariate and multivariate regression analyses were used to create the scoring system with an emphasis on the area improvement under the receiver operating characteristic curve. A total of 58 (47.2%) patients underwent complete laparoscopic surgery, 56 (45.5%) underwent complete open surgery and 9 (7.3%) underwent laparoscopic conversion to open surgery. The final multivariable model included the following three factors: Clinical node stage (P=0.030), Mayo classification (P<0.001) and tumour diameter (P=0.001). These three variables were then used to construct the score system named Peking University Third Hospital Laparoscopic Probability (PKUTHLP), which ranges from 0‑5. The proportion of patients undergoing laparoscopic surgery for each level of the PKUTHLP score were as follows: 0 (n=20), 100%; 1 (n=34), 67.6%; 2 (n=21), 33.3%; 3 (n=21), 19.0%; 4 (n=23), 17.4%; and 5 (n=4), 0.0%. Overall, the PKUTHLP score accurately predicted the probability of using laparoscopic surgery in radical nephrectomy and thrombectomy; however, prospective validation of the PKUTHLP scoring system is required.

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1	Blute ML, Leibovich BC, Lohse CM, Cheville JC and Zincke H: The Mayo Clinic experience with surgical management, complications and outcome for patients with renal cell carcinoma and venous tumour thrombus. BJU Int. 94:33–41. 2004. View Article : Google Scholar : PubMed/NCBI
2	Pouliot F, Shuch B, Larochelle JC, Pantuck A and Belldegrun AS: Contemporary management of renal tumors with venous tumor thrombus. J Urol. 184:833–841. 2010. View Article : Google Scholar : PubMed/NCBI
3	Shao P, Li J, Qin C, Lv Q, Ju X, Li P, Shao Y, Ni B and Yin C: Laparoscopic radical nephrectomy and inferior vena cava thrombectomy in the treatment of renal cell carcinoma. Eur Urol. 68:115–122. 2015. View Article : Google Scholar : PubMed/NCBI
4	Bansal RK, Tu HY, Drachenberg D, Shayegan B, Matsumoto E, Whelan JP and Kapoor A: Laparoscopic management of advanced renal cell carcinoma with renal vein and inferior vena cava thrombus. Urology. 83:812–816. 2014. View Article : Google Scholar : PubMed/NCBI
5	Al Otaibi M, Abou Youssif T, Alkhaldi A, Sircar K, Kassouf W, Aprikian A, Mulder D and Tanguay S: Renal cell carcinoma with inferior vena caval extention: Impact of tumour extent on surgical outcome. BJU Int. 104:1467–1470. 2009. View Article : Google Scholar : PubMed/NCBI
6	Liu Z, Ma LL, Tian XJ, Wang GL, Zhang SD, Huang Y, Hou XF, Zhao L, Lu J, et al: Clinical experience of Mayo 0-IV tumor thrombus treated with radical nephrectomy and inferior vena cava thrombectomy. Chin J Urol. 11:842–847. 2017.(In Chinese).
7	Davenport DL, Bowe EA, Henderson WG, Khuri SF and Mentzer RM Jr: National surgical quality improvement program (NSQIP) risk factors can be used to validate American society of anesthesiologists physical status classification (ASA PS) levels. Ann Surg. 243:636–644. 2006. View Article : Google Scholar : PubMed/NCBI
8	Liu Z, Ma LL, Tian XJ, Wang GL, Hou XF, Zhang SD and Deng SH: Radical nephrectomy and thrombectomy for Mayo clinic stage III tumor thrombus: A surgical technique and clinical experience. Beijing Da Xue Xue Bao Yi Xue Ban. 49:597–602. 2017.(In Chinese). PubMed/NCBI
9	Liu Z, Tang S, Tian X, Zhang S, Wang G, Zhang H and Ma L: Foley catheter-assisted six-step thrombectomy technique in the surgical management of renal cell carcinoma with Mayo level II to IV tumor thrombus. J Int Med Res. 47:2104–2115. 2019. View Article : Google Scholar : PubMed/NCBI
10	Mandal S, Sankhwar SN, Kathpalia R, Singh MK, Kumar M, Goel A, Singh V, Sinha RJ, Singh BP and Dalela D: Grading complications after transurethral resection of prostate using modified Clavien classification system and predicting complications using the Charlson comorbidity index. Int Urol Nephrol. 45:347–354. 2013. View Article : Google Scholar : PubMed/NCBI
11	Inoue T, Kinoshita H, Satou M, Oguchi N, Kawa G, Muguruma K, Murota T and Matsuda T: Complications of urologic laparoscopic surgery: A single institute experience of 1017 procedures. J Endourol. 24:253–260. 2010. View Article : Google Scholar : PubMed/NCBI
12	De Bruyne B, Pijls NH, Kalesan B, Barbato E, Tonino PA, Piroth Z, Jagic N, Möbius-Winkler S, Rioufol G, Witt N, et al: Fractional flow reserve-guided PCI versus medical therapy in stable coronary disease. N Engl J Med. 367:991–1001. 2012. View Article : Google Scholar : PubMed/NCBI
13	Martinez-Salamanca JI, Huang WC, Millan I, Bertini R, Bianco FJ, Carballido JA, Ciancio G, Hernández C, Herranz F, Haferkamp A, et al: Prognostic impact of the 2009 UICC/AJCC TNM staging system for renal cell carcinoma with venous extension. Eur Urol. 59:120–127. 2011. View Article : Google Scholar : PubMed/NCBI
14	Wang W, Xu J, Adams TS, Tian Y and Lv W: Pure retroperitoneal laparoscopic radical nephrectomy for left renal cell carcinoma with differential extensions of level I renal vein tumor thrombus. J Endourol. 28:312–327. 2014. View Article : Google Scholar : PubMed/NCBI
15	Lardas M, Stewart F, Scrimgeour D, Hofmann F, Marconi L, Dabestani S, Bex A, Volpe A, Canfield SE, Staehler M, et al: Systematic review of surgical management of nonmetastatic renal cell carcinoma with vena caval thrombus. Eur Urol. 70:265–280. 2016. View Article : Google Scholar : PubMed/NCBI
16	Lawindy SM, Kurian T, Kim T, Mangar D, Armstrong PA, Alsina AE, Sheffield C, Sexton WJ and Spiess PE: Important surgical considerations in the management of renal cell carcinoma (RCC) with inferior vena cava (IVC) tumour thrombus. BJU Int. 110:926–939. 2012. View Article : Google Scholar : PubMed/NCBI
17	Luciani LG, Porpiglia F, Cai T, D'Elia C, Vattovani V, Giusti G, Tiscione D, Chiodini S, Peschechera R, Fiori C, et al: Operative safety and oncologic outcome of laparoscopic radical nephrectomy for renal cell carcinoma >7 cm: A multicenter study of 222 patients. Urology. 81:1239–1244. 2013. View Article : Google Scholar : PubMed/NCBI
18	Filson CP, Miller DC, Colt JS, Ruterbusch J, Linehan WM, Chow WH and Schwartz K: Surgical approach and the use of lymphadenectomy and adrenalectomy among patients undergoing radical nephrectomy for renal cell carcinoma. Urol Oncol. 30:856–863. 2012. View Article : Google Scholar : PubMed/NCBI
19	Capitanio U, Stewart GD, Larcher A, Ouzaid I, Akdogan B, Roscigno M, Marszalek M, Dell'Oglio P, Salagierski M, Volpe A, et al: European temporal trends in the use of lymph node dissection in patients with renal cancer. Eur J Surg Oncol. 43:2184–2192. 2017. View Article : Google Scholar : PubMed/NCBI
20	Ebbing J, Wiebach T, Kempkensteffen C, Miller K, Bachmann A, Günzel K, Rieken M, Friedersdorff F, Baumunk D and Weikert S: Evaluation of perioperative complications in open and laparoscopic surgery for renal cell cancer with tumor thrombus involvement using the Clavien-Dindo classification. Eur J Surg Oncol. 41:941–952. 2015. View Article : Google Scholar : PubMed/NCBI
21	Xu B, Zhao Q, Jin J, He ZS, Zhou LQ and Zhang Q: Laparoscopic versus open surgery for renal masses with infrahepatic tumor thrombus: The largest series of retroperitoneal experience from China. J Endourol. 28:201–207. 2014. View Article : Google Scholar : PubMed/NCBI