Application Of Modified Zonal NePhRO Scoring System In Nephron-Sparing Surgery For Renal Angiomyolipoma

BackgroundRenal angiomyolipoma(RAML),which is composed of blood vessels,smooth muscle and fat in different proportions,is also known as renal hamartoma.According to histology,RAML can be divided into classic and epithelioid AML(Epithelioid Angiomyolipoma,EAML),and the classic type can be divided into simple sporadic and tuberous sclerosis complex(TSC).Patients have no obvious symptoms in the early stage,and are often found when they are admitted to the hospital due to physical examination or waist and abdominal pain,hematuria or shock.Ultrasound,computed tomography(CT)and magnetic resonance imaging(MRI)have good values in the diagnosis of RAML.For patients with RAML who need surgical treatment have complex conditions,so it is necessary to evaluate the difficulty of surgery,but there is currently no effective scoring system for RAML.PurposeAs a new scoring system for renal tumors,the zonal NePhRO scoring system has a good development trend,but it cannot be fully applied to the evaluation of the difficulty of RAML surgery.The purpose of this study is to improve the existing scoring system according to the characteristics of RAML,and to verify the clinical value of the modified zonal NePhRO scoring system in nephron-sparing surgery on RAML.MethodThe relevant data of patients with pathologically confirmed RAML who underwent nephron-sparing surgery in the Urology Department of our hospital were collected.The differences in the perioperative indicators of different groups in the zonal NePhRO score and modified score were verified.The difficulty of surgery was grouped according to the actual situation by operation time and intraoperative blood loss,and the value of the modified score was verified by comparing the sensitivity and specificity of the zonal NePhRO score and the modified score to the assessment of actual surgical difficulty.ResultAccording to the inclusion and exclusion criteria,in the study,79 patients were eligible for inclusion including 17 males and 62 females.When grouped according to the actual difficulty of surgery,there were 19,21,and 39 patients in the low-,medium-,and high-difficulty groups.There were statistical differences in tumor size,numbers of tumor,tumor location,blood supply and distance from collecting system.According to the modified zonal NePhRO scoring system,the difficulty of surgery was divided into low-,medium-and high-difficulty groups with 23,27 and 29 patients.In terms of operation time,there were statistically significant differences between the highdifficulty group and the low-difficulty group or the medium-difficulty group.There were statistical differences in intraoperative blood loss and warm ischemia time,and there was no statistical difference in postoperative hospital stay among the groups.When the modified scoring system and the zonal NePhRO scoring system predicted the actual difficulty of surgery,the sensitivity of the former was 70.1%,56.3%,52.8%,and the specificity was 81.2%,67.1%,98.6%,while the sensitivity of the latter was 50.6%,40.1%,33.8%,and the specificity was 62.9%,48.9%,94.7%.Except for the specificity in the high-difficulty group,the rest were statistically different.ConclusionWhen the modified zonal NePhRO scoring system is applied to RAML nephronsparing surgery,it has a high value in predicting the difficulty of surgery.As the score increases,the difficulty of surgery also becomes greater.Compared with the zonal NePhRO scoring system,the modified scoring system has higher sensitivity and specificity in low-and medium-difficulty operations,and has higher sensitivity in predicting the high-difficulty group,so it is more conducive to evaluating the difficulty of RAML nephron-sparing surgery.