Can risk scoring systems (R.E.N.A.L, PADUA and (MC)2 scoring systems) and related risk factors predict complications of renal ablation? a meta-analysis.

OBJECTIVE: To evaluate the predictive value of the R.E.N.A.L., PADUA, and (MC)2 scoring systems for complications after renal tumor ablation. METHOD: This systematic review and meta-analysis was reported in accordance with PRISMA and registered in PROSPERO. PubMed, Embase, the Cochrane Library, and Web of Science were searched from inception to May 1, 2025. The primary outcomes were overall, major, and minor complications after renal ablation in relation to the R.E.N.A.L., PADUA, or (MC)2 scoring systems. RESULTS: A total of 25 retrospective studies involving 5,583 patients were included. Higher R.E.N.A.L., PADUA, and (MC)2 score categories were associated with higher odds of major complications after renal ablation. Exploratory analyses suggested that larger tumor diameter, closer proximity to the collecting system, central tumor location, complicated diabetes mellitus, and history of myocardial infarction may be associated with increased odds of complications, although several of these analyses were based on only a small number of studies. CONCLUSIONS: The R.E.N.A.L., PADUA, and (MC)2 scoring systems may help stratify complication risk after renal ablation, particularly for major complications. Findings regarding individual risk factors, especially complicated diabetes mellitus, history of myocardial infarction, and central tumor location, should be considered hypothesis-generating and require validation in larger prospective studies. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/, identifier CRD42024551193.