Journal article
Critical analysis of a simplified Fuhrman grading scheme for prediction of cancer specific mortality in patients with clear cell renal cell carcinoma--Impact on prognosis.
- Becker A Department of Urology, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany. Electronic address: a.becker@uke.de.
- Hickmann D Department of Urology, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany.
- Hansen J Department of Urology, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany.
- Meyer C Department of Urology, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany.
- Rink M Department of Urology, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany.
- Schmid M Department of Urology, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany.
- Eichelberg C Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Germany.
- Strini K Department of Urology, Medical University of Graz, Auenbrugger Platz 1, 8036 Graz, Austria.
- Chromecki T Department of Urology, Medical University of Graz, Auenbrugger Platz 1, 8036 Graz, Austria.
- Jesche J Department of Urology, Medical University of Graz, Auenbrugger Platz 1, 8036 Graz, Austria.
- Regier M Department of Diagnostic and Interventional Radiology, University Medical Center, Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany.
- Randazzo M Department of Urology, University Hospital Zurich, Rämistrasse 100, 8091 Zürich, Switzerland.
- Tilki D Department of Urology, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany.
- Ahyai S Department of Urology, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany.
- Dahlem R Department of Urology, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany.
- Fisch M Department of Urology, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany.
- Zigeuner R Department of Urology, Medical University of Graz, Auenbrugger Platz 1, 8036 Graz, Austria.
- Chun FK Department of Urology, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany.
- 2015-11-02
Published in:
- European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology. - 2016
Cancer specific mortality
Clear cell renal cell carcinoma
Fuhrman grading
Nephrectomy
Survival
Aged
Aged, 80 and over
Analysis of Variance
Biopsy, Needle
Carcinoma, Renal Cell
Databases, Factual
Disease-Free Survival
Female
Germany
Humans
Immunohistochemistry
Kaplan-Meier Estimate
Kidney Neoplasms
Male
Middle Aged
Multivariate Analysis
Neoplasm Grading
Nephrectomy
Observer Variation
Postoperative Complications
Predictive Value of Tests
Prognosis
Retrospective Studies
Risk Assessment
Survival Analysis
Treatment Outcome
English
INTRODUCTION AND OBJECTIVES
The traditional 4-tiered Fuhrman grading system (FGS) is widely accepted as histopathological classification for clear cell renal cell carcinoma (ccRCC) and has shown prognostic value. As intra- and inter-observer agreement are sub-optimal, simplified 2- or 3-tiered FGSs have been proposed. We aimed to validate these simplified 2- or 3-tiered FGSs for prediction of cancer-specific mortality (CSM) in a large study population from 2 European tertiary care centers.
METHODS
We identified and followed-up 2415 patients with ccRCC who underwent radical or partial nephrectomy in 2 European tertiary care centers. Univariable and multivariable analyses and prognostic accuracy analyses were performed to evaluate the ability of several simplified FGSs (i.e. grades I + II vs., grades III + IV, grades I + II vs. grade III and grade IV) to predict CSM.
RESULTS
Independent predictor status in multivariate analyses was proved for the simplified 2-tiered FGS (high-grade vs. low-grade), for the simplified 3-tiered FGS (grades I + II vs. grade III and grade IV) as well as for the traditional 4-tiered FGS. The prognostic accuracy of multivariable models of 77% was identical for all tested models. Prognostic accuracy of the model without FG was 75%.
CONCLUSIONS
A simplified 2- or 3-tiered FGS could predict CSM as accurate as the traditional 4-tiered FGS in a large European study population. Application of new simplified 2- or 3-tiered FGS may reduce inter-observer-variability and facilitate clinical practice without compromising the ability to predict CSM in ccRCC patients after radical or partial nephrectomy.
The traditional 4-tiered Fuhrman grading system (FGS) is widely accepted as histopathological classification for clear cell renal cell carcinoma (ccRCC) and has shown prognostic value. As intra- and inter-observer agreement are sub-optimal, simplified 2- or 3-tiered FGSs have been proposed. We aimed to validate these simplified 2- or 3-tiered FGSs for prediction of cancer-specific mortality (CSM) in a large study population from 2 European tertiary care centers.
METHODS
We identified and followed-up 2415 patients with ccRCC who underwent radical or partial nephrectomy in 2 European tertiary care centers. Univariable and multivariable analyses and prognostic accuracy analyses were performed to evaluate the ability of several simplified FGSs (i.e. grades I + II vs., grades III + IV, grades I + II vs. grade III and grade IV) to predict CSM.
RESULTS
Independent predictor status in multivariate analyses was proved for the simplified 2-tiered FGS (high-grade vs. low-grade), for the simplified 3-tiered FGS (grades I + II vs. grade III and grade IV) as well as for the traditional 4-tiered FGS. The prognostic accuracy of multivariable models of 77% was identical for all tested models. Prognostic accuracy of the model without FG was 75%.
CONCLUSIONS
A simplified 2- or 3-tiered FGS could predict CSM as accurate as the traditional 4-tiered FGS in a large European study population. Application of new simplified 2- or 3-tiered FGS may reduce inter-observer-variability and facilitate clinical practice without compromising the ability to predict CSM in ccRCC patients after radical or partial nephrectomy.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1016/j.ejso.2015.09.023
- PMID 26520403
- Persistent URL
- https://folia.unifr.ch/global/documents/96956
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