【Objective】To assess the stability in clinical application of the R.E.N.A..L scoring system based on image anatomic features of renal tumor

and to investigate the correlation between the scoring system and the choice of surgical patterns of localized renal tumor. 【Methods】 The preoperative CT images and clinical data of 225 patients with localized renal tumor who underwent surgical treatment in PLA General Hospital from August 2011 to August 2012 were analyzed retrospectively. Three radiologists independently scored the renal tumors using the R.E.N.A.L scoring system and got the score of each component such as R (radius )

E (exophytic/endophytic)

N (nearness to collecting system)

A (anterior / posterior)

L (location in relation to polar lines) and h (abut the main renal artery/vein or not) and the sum of components. The consistency of the scores among three observers were compared using statistical methods. Patients were divided into three groups as low

medium

high score based on score sum; surgical procedure were divided into two types: radical nephrectomy and partial nephrectomy; the score sum and its individual component scores were analyzed to determine their relationship to treatment patterns. 【Results】 The consistent rate of score sum and individual component scores among three observers were up to 90% and more (P < 0.001). The different scores deriving from the RENAL scoring system were correlated to different treatment patterns. Compared with patients who underwent laparoscopic radical nephrectomy

the patients treated with laparoscopic partial nephrectomy had a significantly lower score sum (P < 0.001). Age and components of R

N

L

h were related to treatment patterns; patients with greater scores in R

N

L and with tumors about the main renal artery/vein were more likely to undergo laparoscopic radical nephrectomy and adversely

patients with lower scores in R

N

L were more likely to undergo laparoscopic partial nephrectomy (P values were 0.000

0.034

0.034

and 0.012

respectively). And components of E

A and gender of patients and the side of tumor were not related to treatment patterns (P > 0.05). 【Conclusion】 The RENAL scoring system based on image anatomic features of renal tumor has good stability and the scores correlate with surgical patterns significantly. It can be used as a practical tool to assess the anatomic features of renal tumors so as to assist urologists make a reasonable pattern of surgical resection of renal tumors.