title: Application of simplified Fuhrman grading system in clear-cell renal cell carcinoma.
abstract: OBJECTIVE
  To investigate the efficacy of simplified (two- or three-tiered) Fuhrman grading systems as prognostic indicators in clear-cell renal cell carcinoma (RCC).
  
  
  METHODS
  By reviewing records, various clinicopathological factors were assessed in 431 patients who received surgical management for clear-cell RCC. A conventional four-tiered Fuhrman grading system was compared with a modified two-tiered grading system (Fuhrman grades I and II were combined as one class, and grades III and IV as another) and also with a three-tiered grading system (only grades I and II were combined). Efficacies of grading systems were assessed via univariate analyses and multivariate models for prediction of cancer-specific survival.
  
  
  RESULTS
  In univariate analysis, the four-tiered and three-tiered grading systems showed similar accuracies (76.5 vs 76.2%, P =0.614) for predicting cancer-specific survival, which were greater than that of the two-tiered system (72.5%; both P < 0.05). Of the three grading systems, only the three-tiered system was an independent predictor of cancer-specific survival in multivariate analysis (P = 0.046). When receiver operating characteristic-derived areas under the curve (AUCs) of multivariate models for predicting cancer-specific survivals were assessed, AUCs for models including the three-tiered Fuhrman grading system and the conventional four-tiered Fuhrman grading system were the same (95.3%), followed by that of a model incorporating the two-tiered grading system (95.1%).
  
  
  CONCLUSIONS
  A modified, three-tiered Fuhrman grading system can be considered an appropriate option in the application of a nuclear grading system to the prognostication of clear-cell RCC in both univariate analysis and multivariate model setting.
authors.affiliation: Department of Urology, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Sung K
authors.initials: SK
authors.lastname: Hong
authors.forename: Chang W
authors.initials: CW
authors.lastname: Jeong
authors.forename: Ji H
authors.initials: JH
authors.lastname: Park
authors.forename: Hyung S
authors.initials: HS
authors.lastname: Kim
authors.forename: Cheol
authors.initials: C
authors.lastname: Kwak
authors.forename: Gheeyoung
authors.initials: G
authors.lastname: Choe
authors.forename: Hyeon H
authors.initials: HH
authors.lastname: Kim
authors.forename: Sang E
authors.initials: SE
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000145:classification / Q000401:mortality / Q000473:pathology*; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000145:classification / Q000401:mortality / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis