Usefulness of R.E.N.A.L. Nephrometry Scoring System for Predicting Outcomes and Complications of Percutaneous Ablation of 751 Renal Tumors

Abstract

PURPOSE: We applied the R.E.N.A.L. (radius, exophytic/endophytic, nearness to collecting system or sinus, anterior/posterior and location relative to polar lines) nephrometry scoring system to renal tumors treated with percutaneous ablation to determine whether this score is associated with oncological outcomes and complications. MATERIALS AND METHODS: A total of 751 renal tumors were treated at 679 percutaneous ablation sessions in 627 patients at our institution between 2000 and 2012. Of these renal masses 430 (57%) were treated with cryoablation and the remaining 321 were treated with radio frequency ablation. R.E.N.A.L. tumor scores were analyzed to determine the association of the score with ablation treatment outcomes and complications according to Clavien criteria. RESULTS: The mean ± SD R.E.N.A.L. nephrometry score of all ablated tumors was 6.7 ± 1.9. Those treated with cryoablation had higher scores than those treated with radio frequency ablation (mean 7.2 ± 1.9 vs 6.1 ± 1.8, p <0.001). We identified a total of 28 local treatment failures (3.7%) in the 751 tumors during a mean computerized tomography/magnetic resonance imaging followup of 27.9 ± 27.8 months. There was a significant association between R.E.N.A.L. nephrometry score and local treatment failure. Mean nephrometry score was 7.6 ± 2.2 vs 6.7 ± 1.9 for tumors with vs without local treatment failure (p <0.001). Of the 679 ablation treatments 38 (5.6%) major (grade 3 or greater) patient complications occurred. There was a significant association between R.E.N.A.L. nephrometry score and major complications. Patients with vs without a major complication had a mean nephrometry score of 8.1 ± 2.0 vs 6.8 ± 1.9 (p <0.001). CONCLUSIONS: The R.E.N.A.L. nephrometry scoring system predicts treatment efficacy and complications following percutaneous renal ablation.