Laparoscopic Cryoabla.on of Small Renal Tumours Can PADUA Score Predict Treatment Outcome? Tommy Kjærgaard Nielsen, Brunolf W. Lagerveld 2, Øyvind Østraat, Gra.en Andersen 3, Søren Høyer 4, Lasse Nonboe, Ole Graumann 3, Michael Borre Urinvejskirurgisk afd, Aarhus University Hospital. 2 Urinvejskirurgisk afd, St. Lucas Andreas Hospital, Holland. 3 Billeddiagnos.sk afd, Aarhus University Hospital. 4 Patologisk afd, Aarhus University Hospital. Tommy Kjærgaard Nielsen,.reservelæge, ph.d. stud. Urinvejskirurgisk afdeling, Aarhus Universitetshospital E-mail: tomnie@rm.dk
Anatomisk klassifika>on Preopera>ve Aspects and Dimensions Used for an Anatomical (PADUA) Classifica>on of Renal Tumours in Pa>ents who are Candidates for Nephron-Sparing Surgery Vincenzo Ficarra, Giacomo Novara, Silvia Secco, Macchi, Andrea Porzionato, Raffaele De Caro, Walter Ar,bani The R.E.N.A.L. Nephrometry Score: A Comprehensive Standardized System for Quan>ta>ng Renal Tumor Size, Loca>on and Depth Alexander Ku,kov and Robert G. Uzzo
PADUA klassifika>on Score Longitudinal loca.on superior/inferior middle Exophy.c rate > 5% < 5% endophy,c Renal rim lateral medial Renal sinus not involved involved Collec.ng system not involved involved Tumor size < 4 4.-7 > 7 2 2 3 2 2 2 2 3 Score Lav PADUA score 6 7 Intermediær PADUA score 8-9 Høj PADUA score > Ficarra V. Eur Urol, 29
Begge 33 mm, ccrcc, low grade Longitudinal loca.on Exophy.c rate Renal rim Renal sinus Collec.ng system Tumor size Longitudinal loca.on 2 Exophy.c rate 2 Renal rim 2 Renal sinus 2 Collec.ng system 2 Tumor size PADUA Score = 6 PADUA Score =
Arbejdshypotese - Måske er det vanskelig at opnå op,mal nåleplacering/tumordække ved anatomisk komplicerede tumorer? - Måske modvirker blodcirkula,onen nedfrysningen af centrale/endofy,ske tumorer (heatpump effect)? Risikoen for behandlingssvigt ved laparoskopisk cryoabla.on s.ger i takt med en.ltagende PADUA score
Aarhus Universitetshospital, n = 6 St. Lucas Andreas Hospital, n = 96
Pa>ent & tumor karakteris>ka Lav PADUA (6-7) Intermediær PADUA (8-9) Høj PADUA (-4) Antal pa.enter 22 7 (33%) 86 (4%) 56 (26%) p-værdi Alder (år) 65 (64.3-66.5) 63 65 68.4 BMI 27.4 (26.7-28.) CCI 2.9 (2.6-3.2) ECOG >2 37 (3.4%) ASA > 3 67 (3.5%) Tumor størrelse (mm) 28.2 (27.-29.3) 26.5 26.5 33. <. Indlæggelse (dage) 2.2 (.9-2.4).9 2. 2.7.4 Follow-up (mdr) 37.4 (34.4-4.4)
Inkomplet abla>on Mean PADUA score komplet vs. inkomplet abla>on 8. vs..4, p <. Alle pa.enter n = 22 PADUA Score 6-7 8-9 > 7 86 56 Inkomplet abla.on n = (5.2%) (.2%) (7.9%) Longitudinal loca.on superior/inferior middle 2 (.9%) 9 (7.5%) Exophy.c rate > 5% < 5% endophy>c 2 95 5 (.%) 7 (6.9%) 3 (6.7%) Renal rim lateral medial 35 77 8 (5.6%) 3 (3.8%) Renal sinus not involved involved 32 8 (2.%) Collec.ng system not involved involved 2 9 (.8%) Tumor size <4 4.-7 >7 92 2 8 (4%) 3 (3.%) p-værdi <..6 <. <.
Recidiv eller metastase Mean PADUA score komplet vs. recidiv/metastase 8. vs. 9.8, p <. Alle pa.enter n = 2 PADUA Score 6-7 8-9 > 7 85 46 Recidiv eller metastase n = 2 (6.%) 5 (5.9) 7 (5.2) Longitudinal loca.on superior/inferior middle 99 2 (.) (.8) Exophy.c rate > 5% < 5% endophy>c 88 2 (.) 9 (.2) 2 (6.7) Renal rim lateral medial 27 74 7 (5.5) 5 (6.8) Renal sinus not involved involved 32 69 5 (3.8) 7 (.) Collec.ng system not involved involved 2 8 4 (3.3) 8 (.) Tumor size <4 4.-7 >7 92 7 (5.4) 2 (.8) p-værdi.3.5.4
Sygdomsfri overlevelse
Risiko for recidiv eller metastase* 95% CI p-værdi PADUA Score, > (vs. <) 5..6 5.9.6 Tumor størrelse, >25mm (vs. <25mm).3.4-4.2 Exophy.c komponent, <5% (vs. >5%).7 2.5 48.8.2 Placering, midt (vs. øvre/nedre).4 2.3 36.4.3 Placering, medialt (vs. lateralt).2.4 3.7 Samlesystem, involveret (vs. ikke involveret) 2.9.9 9.5 Nyre sinus, involveret (vs. ikke involveret) 4.3.3 4.. Histologi, ccrcc (vs. non-ccrcc) 4.4.6 34.6 ASA score, 3-4 (vs. -2)..3 3.4 ECOC status, >2 (vs. < 2) 2.3. 5.6 CCI, >5 (vs. < 5) 2.7.8 8.9 BMI, >25 (vs. < 25) 2.6.6.9 * Hazard ra>o, justeret for alder & tumorstørrelse
Konklusion PADUA score findes signifikant forøget ved pa>enter som oplever inkomplet abla>on såvel som lokal recidiv eller metastase. Der er op mod 5 gange større risiko for inkomplet abla>on af en tumor med høj PADUA score, sammenlignet med en tumor med lav eller moderat PADUA score. Justeret for alder og tumorstørrelse findes der øget risiko for lokal recidiv eller metastase ved: PADUA score > Eksofy>sk komponent < 5% Central longitudinal placering Involvering af nyre-sinus
TAK FOR OPMÆRKSOMHEDEN Tommy Kjærgaard Nielsen Urinvejskirurgisk afdeling tomnie@rm.dk