Efficacy of combined renal imaging and C-index scoring systems in evaluation of renal mass

Objective: The goal of this study was to evaluate the impact of the renal imaging scoring system (R.E.N.A.L and C-index) on the choice of surgical approaches for T1 stage renal masses. Methods: This study reports retrospective analysis of clinical data from 213 patients, who underwent surgery for renal masses from January 2012 to December 2016, and assessment of imaging data from the R.E.N.A.L and C-index scoring system. Tumors were classified into three groups by R.E.N.A.L first: low, middle and high, then combined with C-index, these three groups are further divided into six group: LL: low (low), LH: low (high), ML: middle (low), MH: middle (high), HL: high (low), HH: high (high). Statistical methods were used to analyze the correlation between RENAL, C-index, and surgical approaches. Results: According to the R.E.N.A.L and C-index scoring system, the complexity of renal tumors is associated with partial nephrectomy (P < 0.01), and intraoperative warm ischemia time (P < 0.01). Among the highlevel R.E.N.A.L. complexity tumors, the proportion of partial nephrectomy was low, but the warm ischemia time was increased. As for the C-index scoring system, tumor complexity also connected with the proportion intraoperative blood loss (P < 0.01). The percent of partial nephrectomy surgery in the patients with high complexity tumors was low, and suffered longer warm ischemia time and more blood loss. Comparing LL with LH, the proportion of partial nephrectomy (P < 0.05), intraoperative warm ischemia time (P < 0.05), and intraoperative bleeding volume (P < 0.05) was statically different. In addition, the proportion of partial nephrectomy (P < 0.05), intraoperative warm ischemia time (P < 0.05), and intraoperative bleeding volume (P < 0.05) show significant differences when comparing ML with MH. However, there is no difference between HL and HH group. Conclusion: The combination of the two scoring systems (R.E.N.A.L. and C-index) might provide more reasonable and accurate choices for surgical approaches and reduction in the occurrence of adverse events.