Prognostic Value of Histologic Subtypes in Renal Cell Carcinoma: A Multicenter Experience

Patard, Jean‐Jacques; Leray, Emmanuelle; Rioux‐Leclercq, Nathalie; Cindolo, Luca; Ficarra, Vincenzo; Zisman, Amnon; Taille, A. De La; Tostain, Jacques; Artibani, Walter; Abbou, Claude C.; Lobel, Bernard; Guilhot, François; Chopin, Dominique; Mulders, Peter F.A.; Wood, C. G.; Swanson, David A.; Figlin, Robert A.; Belldegrun, Arie S.

doi:10.1016/s0022-5347(05)00434-9

Cited by 118 publications

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“…36 The Fuhrman grading system is hampered by a number of factors. As originally defined, the system is based on the simultaneous assessment of three features-nuclear size, nuclear pleomorphism, and nucleolar prominence, without any objective evidence of concordance between these parameters.…”

Section: Fuhrman Gradingmentioning

confidence: 99%

Advances and controversies in grading and staging of renal cell carcinoma

2009

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Despite the considerable progress made in our understanding of the pathogenesis, genetics, and pathology of renal cell carcinoma (RCC), difficulties remain relating to the prediction of clinical outcome for individual cases. Although there is evidence to show that high-grade tumors have a poorer prognosis when compared to those of low grade, debate remains regarding the predictive value of grading, especially for those tumors classified into the intermediate grades. Numerous composite morphologic and nuclear grading systems have been proposed for RCC and although that of the Fuhrman classification have achieved widespread usage, the validity of the grading criteria of this classification has been questioned. In addition, there are few studies that have attempted to validate the Fuhrman system for RCCs beyond that of the clear cell subtype. Recent studies have indicated that grading of papillary RCC should be based on nucleolar prominence alone and that the components of the Fuhrman grading classification do not provide prognostic information for chromophobe RCC. Independent of tumor grade, the prognostic importance of tumor stage for RCC is well recognized. The Union Internationale Contre le Cancer/American Joint Committee for Cancer Staging and End Results Reporting TNM staging system is now in its sixth edition (2002) and recent refinements have focused on defining size cut points that will identify apparently localized tumors that will develop recurrence and/or metastases despite attempted curative surgery. In parallel with these studies it has been shown that infiltration of the renal sinus is an important prognostic factor, being observed in almost all tumors 47 cm in diameter. Questions remain as to the appropriate stratification of regional extension of RCC, as defined in the T3 tumor-staging category. Recent modifications to this category have been suggested combining the level of infiltration of the venous outflow tract with the presence or absence of infiltration of the adrenal gland and/or perirenal fat. Similarly, the utility of classifying lymph node involvement by tumor is debated, although it is well recognized that lymph node infiltration is associated with a poor prognosis. Although the current TNM classification does provide useful prognostic information it would appear that further modifications are justified to enhance the predictive value of staging for RCC.

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Section: Fuhrman Gradingmentioning

confidence: 99%

Advances and controversies in grading and staging of renal cell carcinoma

2009

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“…It is a retrospective design, just like all previous studies that assessed the value of FG in renal cell carcinoma. [2][3][4][5][6][7][8][9][10][11][12][13]15,16 Also, our study is limited by the variables that were recorded in the Surveillance, Epidemiology, and End Results registry. Information on the presence of tumor necrosis and nucleolar prominence would have added to its strength.…”

Section: Discussionmentioning

confidence: 99%

“…9-12 Here, FG was found to accurately predict prognosis and study populations included patients with chromophobe renal cell carcinoma. [9][10][11][12] Based on this lack of consensus, we decided to examine the discriminant accuracy of FG in prediction of cancer-specific mortality after partial or radical nephrectomy for chromophobe renal cell carcinoma patients. Specifically, we tested and quantified the added value of FG relative to other established prognostic factors.…”

mentioning

confidence: 99%

“…1 To date, 11 studies tested the ability of FG in prediction of prognosis in chromophobe renal cell carcinoma. [2][3][4][5][6][7][8][9][10][11][12] Seven of those failed to confirm the value of FG. [2][3][4][5][6][7][8] However, all relied on small sample sizes (n ¼ 49-291), thus power may have been insufficient.…”

mentioning

confidence: 99%

“…[2][3][4][5][6][7][8] Conversely, four other reported the opposite findings. [9][10][11][12] Here, FG was found to accurately predict prognosis and study populations included patients with chromophobe renal cell carcinoma. [9][10][11][12] Based on this lack of consensus, we decided to examine the discriminant accuracy of FG in prediction of cancer-specific mortality after partial or radical nephrectomy for chromophobe renal cell carcinoma patients.…”

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FG has no added value in prediction of mortality after partial and radical nephrectomy for chromophobe renal cell carcinoma patients

et al. 2013

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Our objective was to test whether FG (FG) is applicable in the context of chromophobe renal cell carcinoma patients treated with partial and radical nephrectomy. Patients (n ¼ 1862) with chromophobe renal cell carcinoma treated with partial and radical nephrectomy were identified within the Surveillance, Epidemiology, and End Results (1988-2008). Univariable and multivariable Cox regression analyses were fitted to predict cancer-specific mortality. Discriminant properties were assessed for the conventional four-tiered FG scheme. Additionally, discrimination of the three-tiered FG scheme (1-2 vs 3 vs 4) and the two-tiered FG scheme (1-2 vs 3-4) was also assessed. The statistical significance of the differences in accuracy estimates was compared using the Mantel-Haenszel test. A total of 65 of the 1862 died of the disease. The overall 5-year cancer-specific mortality-free survival rate was 94.8% (95% confidence interval: 93.5-96.2). In univariable analyses, none of the FG strata were significantly associated with cancer-specific mortality. Furthermore, FG was less informative (63%) than tumor size (72%) and tumor stage (69%), using measures of discrimination in univariable analyses. After accounting for all covariates, prediction of 5-year cancer-specific mortality was 79.0% vs 80.3% accurate, respectively, with vs without the consideration of FG (P ¼ 0.01). Similar discrimination estimates were obtained for the modified three-tiered FG scheme (78.5%; P ¼ 0.009) and the modified two-tiered FG scheme (79.5%; P ¼ 0.02). In conclusion, FG is not an informative predictor of prognosis, defined as cancer-specific mortality, after partial and radical nephrectomy for chromophobe renal cell carcinoma patients. Keywords: chromophobe; FG; prognostic factor; renal cell carcinoma FG (FG) represents an important prognostic factor in patients with renal cell carcinoma. 1 It relies on nuclear size, shape, and prominence of nucleoli. 1 To date, 11 studies tested the ability of FG in prediction of prognosis in chromophobe renal cell carcinoma. 2-12 Seven of those failed to confirm the value of FG. 2-8 However, all relied on small sample sizes (n ¼ 49-291), thus power may have been insufficient. [2][3][4][5][6][7][8] Conversely, four other reported the opposite findings. 9-12 Here, FG was found to accurately predict prognosis and study populations included patients with chromophobe renal cell carcinoma. [9][10][11][12] Based on this lack of consensus, we decided to examine the discriminant accuracy of FG in prediction of cancer-specific mortality after partial or radical nephrectomy for chromophobe renal cell carcinoma patients. Specifically, we tested and quantified the added value of FG relative to other established prognostic factors. Additionally, we also compared the gains in discriminant accuracy related to the use of the conventional four-tiered FG scheme relative to a modified three-13 and two-tiered 14 FG schemes.

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Characterizing the outcomes of metastatic papillary renal cell carcinoma

et al. 2017

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Outcomes of metastatic papillary renal cell carcinoma (pRCC) patients are poorly characterized in the era of targeted therapy. A total of 5474 patients with metastatic renal cell carcinoma (mRCC) in the International mRCC Database Consortium (IMDC) were retrospectively analyzed. Outcomes were compared between clear cell (ccRCC; n = 5008) and papillary patients (n = 466), and recorded type I and type II papillary patients (n = 30 and n = 165, respectively). Overall survival (OS), progression‐free survival (PFS), and overall response rate (ORR) favored ccRCC over pRCC. OS was 8 months longer in ccRCC patients and the hazard ratio of death was 0.71 for ccRCC patients. No differences in PFS or ORR were detected between type I and II PRCC in this limited dataset. The median OS for type I pRCC was 20.0 months while the median OS for type II was 12.6 months (P = 0.096). The IMDC prognostic model was able to stratify pRCC patients into favorable risk (OS = 34.1 months), intermediate risk (OS = 17.0 months), and poor‐risk groups (OS = 6.0 months). pRCC patient outcomes were inferior to ccRCC, even after controlling for IMDC prognostic factors. The IMDC prognostic model was able to effectively stratify pRCC patients.

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Prognostic Value of Histologic Subtypes in Renal Cell Carcinoma: A Multicenter Experience

Cited by 118 publications

References 0 publications

Advances and controversies in grading and staging of renal cell carcinoma

Advances and controversies in grading and staging of renal cell carcinoma

FG has no added value in prediction of mortality after partial and radical nephrectomy for chromophobe renal cell carcinoma patients

Characterizing the outcomes of metastatic papillary renal cell carcinoma

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