Prognostic ability of simplified nuclear grading of renal cell carcinoma.
BACKGROUND
The Fuhrman grading system is an established predictor of survival in patients with renal cell carcinoma (RCC). The predictive accuracy of various Fuhrman grading schemes was tested with the intent of improving the prediction of RCC-specific survival (RCC-SS).


METHODS
The analyses targeted 5453 patients from 14 institutions. Univariable, multivariable, and predictive accuracy analyses addressed RCC-SS. The statistical significance of the gain in predictive accuracy was quantified with the Mantel-Haenszel test.


RESULTS
The median follow-up time was 4.5 years. In both univariable and multivariable analyses, Fuhrman grade achieved independent predictor status regardless of the coding scheme. When Fuhrman grade was not considered in multivariable analyses, the predictive accuracy was 83.8%. Addition of Fuhrman grade to the multivariable model resulted in predictive accuracy gains of 0.8% for all 3 grading schemes tested.


CONCLUSIONS
Fuhrman grade must to be considered when RCC-SS is assessed. However, modified or conventional Fuhrman grading schemes perform equally well as the conventional grading system.
Rioux-Leclercq
Nathalie
N
Department of Pathology, Rennes Hospital, Rennes, France. nathalie.rioux@chu-rennes.fr
Karakiewicz
Pierre I
PI
Trinh
Quoc-Dien
QD
Ficarra
Vincenzo
V
Cindolo
Luca
L
de la Taille
Alexandre
A
Tostain
Jacques
J
Zigeuner
Richard
R
Mejean
Arnaud
A
Patard
Jean-Jacques
JJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000401:mortality* / Q000473:pathology*; D002467:Cell Nucleus / Q000473:pathology*; D002648:Child; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D016019:Survival Analysis