title: Reclassification of the Fuhrman grading system in renal cell carcinoma-does it make a difference?
abstract: OBJECTIVE
  The aim of this study was to determine whether reclassifying the Fuhrman grading system provides further prognostic information.
  
  
  METHODS
  We studied the pathological features and cancer specific survival of 237 patients with clear cell cancer undergoing surgery between 1997-2007 in a single centre. The original Fuhrman grading system was investigated as well as various simplified models utilising the original Fuhrman grade.
  
  
  RESULTS
  The median follow up was 69 months. On univariate analysis, the conventional Fuhrman grading system as well various simplified models were predicative of cancer specific survival. On multivariate analysis, only the three tiered modified model in which grades 1 and 2 were combined whilst grades 3 and 4 were kept separate was an independent predictor of cancer specific survival (p=0.001, HR 2.17, 95% CI 1.37-3.43). Furthermore this simplified model demonstrated a stronger relationship to recurrence than the conventional 4 tiered Fuhrman grading system.
  
  
  CONCLUSIONS
  A modified, three-tiered Fuhrman grading system has been demonstrated to be an independent predictor of cancer specific survival.
authors.affiliation: Unit of Experimental Therapeutics, Institute of Cancer, College of MVLS, University of Glasgow, Western Infirmary, Glasgow, G11 6NT Scotland, UK.
authors.forename: Tahir
authors.initials: T
authors.lastname: Qayyum
authors.forename: Peter
authors.initials: P
authors.lastname: McArdle
authors.forename: Clare
authors.initials: C
authors.lastname: Orange
authors.forename: Morag
authors.initials: M
authors.lastname: Seywright
authors.forename: Paul
authors.initials: P
authors.lastname: Horgan
authors.forename: Grenville
authors.initials: G
authors.lastname: Oades
authors.forename: Michael
authors.initials: M
authors.lastname: Aitchison
authors.forename: Joanne
authors.initials: J
authors.lastname: Edwards
keywords: Fuhrman grade; Renal cell cancer