O.A. Voilenko, O.E. Stakhovskyi, O.A. Kononenko, S.L. Semko, M.V. Pikul, Y.V. Vitruk, E.A. Stakhovsky
Multivariate analysis of parameters affecting the choice of surgical treatment for patients with localized renal cell carcinoma (RCC)
Objective. To increase the effectiveness of treatment the patients with localized RCC on the basis of determining the main clinical and nephrometric criteria that affect the choice of surgical treatment.
Маterials and methods. Results of a retrospective analysis of treatment of 903 patients with localized RCC (T1-T2 N0 M0), which evaluated nephrometric, clinical parameters. Patients are divided into two groups depending on the type of treatment: the group of partial nephrectomy (PN) - 658 patients, the group of radical nephrectomy (RN) - 245.
Results. A multivariate analysis of the main clinical, anatomical and nephrometrical criterias by the method of the neural network prediction model found that the most valid indicators affecting the choice of indications for PN or RN was: tumor size, localtion, the volume of functioning renal parenchyma. Nomograms and an electronic calculator developed on this basis make it possible to accurately predict the choice of surgical treatment method for patients (sensitivity 85,5% (95% CI 81,3-89,0%) and specificity 85.5% (95% CI 82,3 -88,3%)).
Conclusion. In case of polar and lateral location of RCC, the indication for PN was the volume of functioning renal parenchyma of more than 58% and 67%, respectively. In case of hilar location of RCC, the main indication for PN was the tumor size of less than 38 mm.