A Proposal for Reclassification of the Fuhrman Grading System in Patients with Clear Cell Renal Cell Carcinoma.

TY - JOUR

T1 - A Proposal for Reclassification of the Fuhrman Grading System in Patients with Clear Cell Renal Cell Carcinoma.

AU - Sun, Maxine

AU - Lughezzani, Giovanni

AU - Jeldres, Claudio

AU - Isbarn, Hendrik

AU - Shariat, Shahrokh F

AU - Arjane, Philippe

AU - Widmer, Hugues

AU - Pharand, Daniel

AU - Latour, Mathieu

AU - Perrotte, Paul

AU - Patard, Jean-Jacques

AU - Karakiewicz, Pierre I

PY - 2009

Y1 - 2009

N2 - 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.

AB - 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.

M3 - SCORING: Zeitschriftenaufsatz

JO - EUR UROL

JF - EUR UROL

SN - 0302-2838

ER -