A New Nephrometry Score for Predicting Positive Surgical Margin After Laparoscopic Partial Nephrectomy

Area of Science:

• Urology
• Surgical Oncology
• Medical Imaging

Background:

• Accurate prediction of positive surgical margins (PSM) is crucial for successful partial nephrectomy (PN).
• Current nephrometry scores (RENAL, PADUA, C-index) have limitations in predicting PSM.
• Novel imaging-based parameters are needed to improve predictive accuracy.

Purpose of the Study:

• Introduce the KESKIN ratio as a new predictor of PSM in laparoscopic PN.
• Evaluate the KESKIN ratio against established clinical factors and nephrometry scores.
• Assess the KESKIN ratio's utility in predicting PSM after PN.

Main Methods:

• Retrospective analysis of 95 patients undergoing laparoscopic PN.
• Calculation and evaluation of the KESKIN ratio, tumor characteristics, and nephrometry scores.
• Statistical analysis including univariate and multivariate regression to identify PSM predictors.

Main Results:

• The KESKIN ratio was the sole statistically significant predictor of PSM (p = 0.007 univariate, p = 0.043 multivariate).
• Established scores (RENAL, PADUA, C-index) did not significantly predict PSM.
• A KESKIN ratio cutoff of 0.5 was identified, with higher values indicating increased PSM risk.

Conclusions:

• The KESKIN ratio is a novel, easily calculable parameter for predicting PSM in laparoscopic PN.
• The KESKIN ratio demonstrates superior predictive value compared to existing scoring systems.
• External validation in larger cohorts may support integrating the KESKIN ratio into future nephrometry guidelines.