The Chromophobe Tumor Grading System is the Preferred Grading Scheme for Chromophobe Renal Cell Carcinoma

Finley, David S.; Shuch, Brian; Said, Jonathan; Galliano, Gretchen; Jeffries, Robin A.; Afifi, Abdelmonem A.; Castor, Brandon; Magyar, Clara E.; Sadaat, Ardavan; Belldegrun, Arie S.

doi:10.1016/j.juro.2011.07.068

Cited by 29 publications

(35 citation statements)

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“…[2][3][4][5][6][7][8] However, all seven-investigator groups relied on relatively small patient samples (n ¼ 49-291) and all tested FG in multivariate analyses. [2][3][4][5][6][7][8] Lack of statistical significance in such analyses may originate from insufficient sample size. Based on this consideration, we decided to test the added value of FG in a large populationbased sample of individual treated with partial or radical nephrectomy for chromophobe renal cell carcinoma.…”

Section: Discussionmentioning

confidence: 99%

“…Both grading schemes failed to achieve independent predictor status in multivariable analysis. 4 Nonetheless, the chromophobe grading system represented an example of a potentially valuable grading scheme. It awaits further testing in large patient populations.…”

Section: Discussionmentioning

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][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. [2][3][4][5][6][7][8] Conversely, four other reported the opposite findings.…”

mentioning

confidence: 99%

“…[2][3][4][5][6][7][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][10][11][12] Here, FG was found to accurately predict prognosis and study populations included patients with chromophobe renal cell carcinoma.…”

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confidence: 99%

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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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