Could renal tumour scoring systems predict tumour aggressivity?

Abstract

Objective: The aim of this study is to investigate the relationship between R.E.N.A.L. nephrometry score (RNS), Padua score (PS), Centrality (C)-index and tumour aggressivity in T1 renal tumours and to question whether these scoring systems would provide information about the pathology of renal tumours to manage clinical judgement rather than the anatomy of tumour. Material and Methods: We evaluated 83 patients with stage 1 (T1N0M0) clear cell renal cell carcinoma (cRCC) according to preoperative radiological and pathological staging. Patients were divided according to pathological results of cRCC into two groups: Patients with Fuhrman grade 1 or 2 (FG1-2) (Non-aggresive group (NAG)) and patients with FG3-4 and/or TNM Stage 3 (Aggressive group (AG)). RNS, PS and C-index scores were calculated for each patient. Finally,the relationship between nephrometry scores and pathological aggressivity were compared. Results: The mean RNS was calculated as 7.3±2.4. Total RNS was significantly higher in AG (9.2±1.2) than in NAG (6±2.2) (p<0.001). RNS was an independent predictor of pathological aggressive disease (p<0.001). The cut off value of RNS at the highest area under curve was 8 (p<0.001). The mean PS was calculated as 8.1±1.6. PS was also an independent predictor of pathological aggressive disease (p<0.001). The cut off value of PS at the highest area under curve was 8 (p<0.001). The mean C-index score of AG (1.4 ± 0.4) was significantly lower (p<0.001) than NAG (2.7±2.0). C-index is significant in predicting pathological aggressiveness (p<0.001). Conclusions: Our results suggested that higher RNS and PS scores, lower C-index scores were associated with tumour aggressivity of renal tumours.