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Minerva Urologica e Nefrologica 2020 Apr 16

DOI: 10.23736/S0393-2249.20.03813-8

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Comprehensive long-term assessment of outcomes following robot-assisted partial nephrectomy for renal cell carcinoma: the ROMe’s achievement and its predicting nomogram

Aldo BRASSETTI 1 , Umberto ANCESCHI 1, Riccardo BERTOLO 2, Mariaconsiglia FERRIERO 1, Gabriele TUDERTI 1, Manuela COSTANTINI 1, Umberto CAPITANIO 3, Alessandro LARCHER 3, Alessandro ANTONELLI 4, Alexander MOTTRIE 5, Andrea MINERVINI 6, Paolo DELL’OGLIO 5, Alessandro VECCIA 4, Daniele AMPARORE 7, Rocco S. FLAMMIA 8, Riccardo LOMBARDO 10, Cosimo DE NUNZIO 10, Luigi BENECCHI 11, Andrea MARI 6, Francesco PORPIGLIA 7, Francesco MONTORSI 3, Jihad KAOUK 2, Riccardo AUTORINO 9, Michele GALLUCCI 1, 8, Giuseppe SIMONE 1

1 Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy; 2 Glickman Urological and Kidney Institute, Cleveland Clinic, OH, USA, Cleveland Clinic, Cleveland, OH, USA; 3 Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy; 4 Department of Urology, Spedali Civili di Brescia, Brescia, Italy; 5 Department of Urology, OLV Hospital, Aalst, Belgium; 6 Department of Urology, Careggi Hospital, University of Florence, Florence, Italy; 7 Division of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy; 8 Department of Urology, Policlinico Umberto I, Sapienza University, Rome, Italy; 9 Division of Urology, Department of Surgery, Virginia Commonwealth University Health System, Richmond, VA, USA; 10 Department of Urology, Sant’Andrea Hospital, Sapienza University, Rome, Italy; 11 Department of Urology, Istituti Ospitalieri di Cremona, Cremona, Italy


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BACKGROUND: We proposed a new tool (named ROMe’s) to summarize long-term outcomes after partial nephrectomy (PN), identified its predictors and generated a predicting nomogram.
METHODS: A retrospective analysis of a multicenter dataset of patients with non-metastatic pT1-3a renal cell carcinoma was performed. Baseline demographic, clinical, pathologic and perioperative data were collected. ROMe’s was defined as the concomitant lack of cancer- recurrences, death and newly onset Chronic Kidney Disease (CKD), at long term follow-up. Kaplan-Meier method investigated the predictive role of Trifecta on ROMe’s achievement. Univariable and multivariable Cox regression analyses identified its predictors. A nomogram was generated and its accuracy was quantified using concordance index (CI). A calibration plot was obtained with 200 bootstraps resampling to explore nomogram performance at 5 years and decision curve analyses (DCA) assessed the net benefit of the model at 12, 36 and 60 months.
RESULTS: We included 927 patients. The rates of ROMe’s were 82%, 72% and 56% at 1, 3 and 5 years follow-up. At Kaplan-Meier analysis, patients who achieved Trifecta displayed a significantly higher probability of ROMe’s (log rank p <0.001). Young age (OR=0.982; p=0.001), low RENAL score (OR=0.86; p=0.037), high preoperative filtration rate (OR=1.02; p<0.001) and Trifecta achievement (OR=2.03; p=0.015), were independent predictors of ROMe’s. The nomogram showed a CI of 0.76 at 60 months. The 5-years calibration plot confirmed a good discrimination accuracy (0.74); on DCA, the net benefit of using the model was evident for probabilities > 30%.
CONCLUSIONS: We conceived a triad to summarize the main long-term oncologic and functional outcomes after PN and generated a predicting nomogram.


KEY WORDS: Renal cancer; Partial nephrectomy; Renal function; Survival; Trifecta

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