Zhou et al al reported the Zhngshan Score for evaluating a patient with a renal tumor. This can help in the evaluation of a patient who may be a candidate for nephron-sparing surgery. The authors are from Zhongshan Hospital and Fudan University in Shanghai.
Parameters:
(1) maximum tumor diameter within renal parenchyma in cm, rounded (Ri)
(2) physical location as lateral, medial or central
(3) depth of tumor invasion
|
Parameter
|
Finding
|
Points
|
|
maximum tumor diameter
|
|
|
|
location
|
lateral
|
1
|
|
|
medial
|
2
|
|
|
central
|
3
|
|
depth of invasion
|
cortex only
|
1
|
|
|
medulla involved
|
2
|
|
|
urinary collecting system and/or renal sinus
|
3
|
where:
• The maximum tumor diameter is also seen in the Zero Ischemia Index of Li et al (also from Fudan University). It is length of the line in cm connecting the 2 points where the tumor crosses the renal capsule (Ri)
• Location is relative to a line that divides the kidney into medial and lateral zones.
• A tumor is termed central when it touches the hilar vessels or intrarenal segmental vessels.
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: around 3
• maximum score: 13 or more (depending on diameter)
• The higher the scorer the greater the surgical risk.
|
Total Score
|
Risk Group
|
|
< 5
|
low
|
|
5 to 7
|
moderate
|
|
>= 8
|
high
|
Performance:
• The area under the ROC curve is 0.62 for surgical complications.
• The area under the ROC curve is 0.85 for conversion to radical nephrectomy
