title: Prognostic ability of simplified nuclear grading of renal cell carcinoma.
abstract: 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.
authors.affiliation: Department of Pathology, Rennes Hospital, Rennes, France. nathalie.rioux@chu-rennes.fr
authors.forename: Nathalie
authors.initials: N
authors.lastname: Rioux-Leclercq
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
authors.forename: Quoc-Dien
authors.initials: QD
authors.lastname: Trinh
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Ficarra
authors.forename: Luca
authors.initials: L
authors.lastname: Cindolo
authors.forename: Alexandre
authors.initials: A
authors.lastname: de la Taille
authors.forename: Jacques
authors.initials: J
authors.lastname: Tostain
authors.forename: Richard
authors.initials: R
authors.lastname: Zigeuner
authors.forename: Arnaud
authors.initials: A
authors.lastname: Mejean
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Patard
mesh_terms: 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