The following is a summary of “A novel multiplex score to predict outcomes of partial nephrectomy for multiple tumors,” published in the May 2023 issue of the Urologic Oncology by Chalfin et al.

The RENAL nephelometry score (RNS) is commonly employed to characterize the complexity of renal mass and inform patient counseling for partial nephrectomy (PN). However, which factors influence perioperative outcomes in cases involving multiple malignancies is unknown. The objective is to assess the efficacy of multiplex PN at the researchers’ institution using a novel scoring equation (multiplex score [MS]) derived from RNS. A single surgeon performed a total of 62 consecutive multiplex PN (median (range) number of tumors = 4(2–11), 65% robotic) procedures. 

A priori, the MS was defined as a weighted score derived from RNS (# low risk ([LR] lesions) + 2*(# intermediate risk [IR] + 4*(# high risk [HR]) based on published complication rates. MS was divided into favorable and adverse categories based on its median score. Prospective patient outcomes were maintained. MS was compared to other possible RNS-derived scoring methods. There were a total of 249 tumors scored. Median (range) MS was 6 (range 2-20, IQR 3–8). About 10 patients experienced complications (16.1%). MS was associated with perioperative complications (P = 0.02) and blood loss (P<.001); the favorable MS(<6) group experienced only one difficulty. MS had the most significant area under the curve (AUC) for predicting operative complications (0.75) compared to other potential scoring systems. Blood loss and complications were associated with the novel MS. 

This instrument may facilitate standardized reporting of the complexity of multiplex series, with particular application to inherited cancer syndromes. There are established scoring systems for patients with a single kidney tumor to assist patients and surgeons in determining the optimal surgical approach. Nonetheless, no scoring system exists for patients with multiple renal tumors. Here, the “Multiplex Score” facilitates collaborative decision-making in cases involving various renal tumors.

Source: sciencedirect.com/science/article/abs/pii/S1078143923000923