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A proposal for reclassification of the Fuhrman grading system in patients with clear cell renal cell carcinoma.

Abstract：

BACKGROUND:The conventional Fuhrman grading system, which categorizes renal cell carcinoma (RCC) with grades I, II, III, and IV, is the most widely used predictor assessment of RCC cancer-specific mortality (CSM). OBJECTIVES:The aim of this study was to test the prognostic ability of simplified Fuhrman grading schemes (FGSs) that rely on two- or three-tiered classifications. DESIGN, SETTING, AND PARTICIPANTS:The current study addressed a population of 14064 patients with clear cell RCC who were treated with partial or radical nephrectomy between 1988-2004, within nine Surveillance, Epidemiology, and End Results (SEER) cancer registries. MEASUREMENTS:Univariable and multivariable analyses as well as prognostic accuracy analyses were performed for various FGSs to test their ability to predict CSM rates. The conventional four-tiered FGS was compared to a modified two-tiered FGS in which grades I and II and grades III and IV were combined. A second simplified three-tiered FGS in which grades I and II were combined but grades III and IV were kept separate was also tested. RESULTS AND LIMITATIONS:The overall 5-yr CSM-free rate was 81.5%. All three FGSs achieved independent predictor status in multivariable analyses. Prognostic accuracy of multivariable models that relied on various FGSs was 83.6% for the modified two-tiered FGS and 83.8% for both the conventional four-tiered and the modified three-tiered FGS. CONCLUSIONS:Our findings indicate that the simplified FGSs perform equally as well as the conventional four-tiered FGS. The use of simplified grading schemes may represent an advantage for pathologists as well as for clinicians caring for patients with RCC.

journal_name

Eur Urol

journal_title

European urology

authors

Sun M,Lughezzani G,Jeldres C,Isbarn H,Shariat SF,Arjane P,Widmer H,Pharand D,Latour M,Perrotte P,Patard JJ,Karakiewicz PI

doi

10.1016/j.eururo.2009.06.008

subject

Has Abstract

pub_date

2009-11-01 00:00:00

pages

775-81

issue

5

eissn

0302-2838

issn

1873-7560

pii

S0302-2838(09)00590-9

journal_volume

56

pub_type

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