Prognostic Value of Renal Cell Carcinoma Nuclear Grading: Multivariate Analysis of 333 Cases

Ficarra, Vincenzo; Righetti, Rita; Martignoni, Guido; D’Amico, Antonio; Pilloni, Stefania; Rubilotta, Emanuele; Malossini, G.; Mobilio, G.

doi:10.1159/000050968

Cited by 93 publications

(50 citation statements)

References 15 publications

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“…In studies limited to clear cell RCC, where statistical analysis was undertaken, significant differences in survival were demonstrated between all grades or combined grades 1 and 2, grade 3 and 4 tumors. 37,38,40 These data, however, did not always retain significance on multivariate analysis against a variety of staging parameters (local extension nodal and distant metastases). 38,40 In addition, Fuhrman grading has been shown to correlate with outcome for pT1 clear cell RCC, irrespective of tumor size although tumors were grouped (G1 þ G2 vs G3 þ G4) for statistical analysis.…”

Section: Fuhrman Gradingmentioning

confidence: 92%

“…37,38,40 These data, however, did not always retain significance on multivariate analysis against a variety of staging parameters (local extension nodal and distant metastases). 38,40 In addition, Fuhrman grading has been shown to correlate with outcome for pT1 clear cell RCC, irrespective of tumor size although tumors were grouped (G1 þ G2 vs G3 þ G4) for statistical analysis. 42 For papillary RCC there are little data regarding the prognostic significance of Fuhrman grading although in two series grading did not achieve a significant relationship with outcome on multivariate analysis that included tumor stage.…”

Section: Fuhrman Gradingmentioning

confidence: 92%

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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: 92%

Section: Fuhrman Gradingmentioning

confidence: 92%

Advances and controversies in grading and staging of renal cell carcinoma

2009

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“…The modified twotiered FG scheme revealed that FG 3-4 patients had a 1.7-fold higher rate of cancer-specific mortality relative to FG 1-2, after adjusting for the effect of all other variables. [17][18][19] In multivariable analyses of discriminant accuracy (Table 3), the multivariable model that included all variables except FG, resulted in 80.3% accuracy. Conversely, the multivariable model that included the conventional four-tiered FG scheme reached 79% accuracy.…”

Section: Resultsmentioning

confidence: 99%

“…20 The stage of the primary, presence of lymphnode invasion, presence of distant metastases, and tumor grade represent examples of established predictors. [17][18][19]21 In renal cell carcinoma, FG represents the most widely used grade stratification scheme. 1 It was endorsed for use in renal cell carcinoma by the Rochester Renal Cell Carcinoma Consensus Conference, with additional endorsement by the College of American Pathologists.…”

Section: Discussionmentioning

confidence: 99%

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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“…This is partly because, as yet, no consensus has been reached on a universal tumor grading system (Kanamaru et al 2001, Medeiros et al 1997. The observed five-year disease-specific survival (DSS) rate is approximately 90% for G1, 70-85% for G2, 45-60% for G3, and 15-30% for G4 (Gudbjartsson et al 2005, Ficarra et al 2001. Currently, different grading systems are utilized at different institutions.…”

Section: Histopathological Tumor Gradingmentioning

confidence: 99%

Prognostic Factors in Renal Cell Carcinoma: An Evaluation of T-Stage, Histopathological Grade, p53, Ki-67, COX-2, and Her-2 Expressions

Kankuri-Tammilehto¹

2012

Emerging Research and Treatments in Renal Cell Carcinoma

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Prognostic Value of Renal Cell Carcinoma Nuclear Grading: Multivariate Analysis of 333 Cases

Cited by 93 publications

References 15 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

Prognostic Factors in Renal Cell Carcinoma: An Evaluation of T-Stage, Histopathological Grade, p53, Ki-67, COX-2, and Her-2 Expressions

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