Preoperative risk calculator for the probability of completing nephron sparing for kidney cancer

Area of Science:

• Urology
• Oncology
• Surgical Outcomes

Background:

• Preoperative estimation of partial nephrectomy (PN) completion is subjective and inaccurate without predictive models.
• Renal mass treatment decisions between PN and radical nephrectomy (RN) require objective probability assessment.

Purpose of the Study:

• To develop an evidence-based model for objectively assessing the probability of PN completion.
• To identify patient characteristics, tumor complexity, urologist expertise, and surgical approach as predictors of PN completion.

Main Methods:

• A multivariable logistic regression model was developed using data from 675 patients treated for cT1-2 cN0 cM0 renal masses.
• Tumor complexity was assessed using the SPARE score. Model validation was performed using bootstrap analysis.
• Predictors of PN completion, including tumor size, SPARE score, surgeon experience, and surgical approach (robotic, open, laparoscopic), were investigated.

Main Results:

• PN was performed in 53% of cases. Factors associated with higher PN completion probability included smaller tumors, lower SPARE scores, greater surgeon experience, and robotic or open approaches over laparoscopic.
• The developed model demonstrated a high predictive accuracy of 0.94 (95% CI 0.93-0.95).

Conclusions:

• The probability of PN completion for renal masses can be accurately predicted preoperatively using routinely available clinical information.
• The proposed model can aid in preoperative decision-making, patient consent, and counseling for renal mass surgery.