Prognostic value of nuclear grade of renal cell carcinoma

Abstract

Background. The authors assessed the interest and the value of Fuhrman's nuclear grade as a possible prognostic factor for renal cell carcinoma (RCC). Methods. An 11‐year retrospective study of 190 patients with RCC treated by radical nephrectomy was performed. The distribution by grade was: Grade I, 54 patients; Grade II, 58; Grade III, 58; and Grade IV, 20. The distribution of the patients by tumor stage according to the TNM15 classification was: pT1, 56 patients; pT2, 41; pT3a, 55; pT3b, 25; pT3c + pT3d + pT4b, 5; and pT4a, 8. Significant correlations with other prognostic parameters were noted. Survival curves by grade were evaluated by the Kaplan‐Meier method. Results. Nuclear grade was correlated with tumor stage (P = 0.0001), synchronous metastases (P = 0.003), lymph node involvement (P = 0.0001), renal vein involvement (P = 0.0001), tumor size (P = 0.0001), and perirenal fat involvement (P = 0.001). No correlation was found between nuclear grade and tumor multicentricity (P = 0.14) and cell type (P = 0.2). Nuclear grade was an effective parameter in predicting development of distant metastases after nephrectomy. Among the 54 patients who presented with Grade I tumors, only one tumor did metastasize during the 5‐year follow‐up, whereas 17% of the Grade III and 30% of the Grade IV tumors metastasized. The 5‐year actuarial survival rates of the patients with Grade I, II, III, and IV tumors was 76%, 72%, 51%, and 35%, respectively. The comparison of the survival curves by grade showed a statistically significant difference between the curves when Grade I and II tumors were compared with Grade III and IV tumors (P = 0.001). Conclusion. In this study, nuclear grade was found to have prognostic significance and seems to be an important criterion when considering the outcome of patients with RCC.

Comparison of chromosomal aberrations detected by fluorescence in situ hybridization with clinical parameters, DNA ploidy and Ki 67 expression in renal cell carcinoma

“…The significance of tumour stage as a prognostic indicator for RCC is recognized (Nurmi, 1984), whereas it is controversial for a grading system to be reliable regarding prognostic relevance because of the interobserver variation (Fuhrman et al, 1982;Bretheau et al, 1995;Lanigan, 1995). However, our data demonstrated that specific chromosomal aberration detected by FISH was correlated with tumour stage and nuclear grade.…”

Re‐evaluation of the Tumour‐Node‐Metastasis staging of locally advanced renal cortical tumours: absolute size (T2) is more significant than renal capsular invasion (T3a)

“…Similar to previously published studies, our analysis showed the prognostic value of Fuhrman grade in predicting clinical outcome [8,9]. When analysing survival based on tumour size alone, we determined that comparing tumours of £ 8.0 cm in greatest dimension to those ≥ 8.0 cm gave a significant difference in disease-free survival ( P = 0.015).…”

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

“…Recently again, a joint group of urologists and pathologists has published a proposal that the criteria for nuclear grading should be different for the different histopathologic subtypes of RCC according to the Heidelberg classification (Paner et al 2006). Additionally, reducing the grades in the Fuhrman system has been proposed, for better outcome stratification (Rioux-Leclercq et al 2007, Lohse et al 2002, Bretheau et al 1995. Overall, histopathological grade seem to be imprecise for prognostic evaluation in RCC patients (Uchida et al 2002, Rioux-Leclercq et al 2000, Lanigan et al 1994).…”