title: The Fuhrman grading system has no prognostic value in patients with nonsarcomatoid chromophobe renal cell carcinoma.
abstract: The prognostic value of the Fuhrman nuclear grading system has been questioned for chromophobe renal cell carcinoma (chRCC) because this subtype frequently displays nuclear and nucleolar pleomorphism. The present study reevaluates this grading system in a series of patients with nonsarcomatoid chRCC. We identified 176 patients (3.6%) with nonsarcomatoid chRCC in a total of 4897 patients who underwent surgery for renal cell carcinoma at 5 centers in Germany between 1990 and 2010. The mean follow-up was 51.1 months. The 3 groups (G1 versus G2 versus G3/4) were comparable in terms of age, sex, tumor diameter, and lymph node metastasis. They only differed significantly in tumor stage (P = .01) and the incidence of synchronous visceral metastasis (P = .04). The 5-year cancer-specific survival rates were 84.4% for G1 (n = 32), 84.3% for G2 (n = 108), and 74.1% for G3/4 tumors (n = 33) (P = .58). Accordingly, multivariate analysis including age, sex, tumor stage, and metastatic disease did not identify Fuhrman grading as an independent predictor of cancer-specific survival in patients with chRCC (P = .4). We were able to demonstrate in a large multicenter cohort that the Fuhrman grading system does not qualify as a prognostic tool in patients with chRCC.
authors.affiliation: Department of Urology and Urological Oncology, Hannover University Medical School, D-30625 Hannover, Germany. Electronic address: Steffens.sandra@mh-hannover.de.
authors.forename: Sandra
authors.initials: S
authors.lastname: Steffens
authors.affiliation: Department of Urology and Pediatric Urology, Saarland University Medical Center and Saarland University Faculty of Medicine, D-66421 Homburg/Saar, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Janssen
authors.affiliation: Department of Urology, Mainz University Medical Center, D-55101 Mainz, Germany.
authors.forename: Frederik C
authors.initials: FC
authors.lastname: Roos
authors.affiliation: Boxberg Centre, Urological Group and Clinic Derout/Pönicke/Becker, D-66538 Neunkirchen, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Becker
authors.affiliation: Department of Urology, Ulm University Medical Center, D-89075 Ulm, Germany.
authors.forename: Julie
authors.initials: J
authors.lastname: Steinestel
authors.affiliation: Institute of Pathology, Hannover University Medical School, D-30625 Hannover, Germany.
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Abbas
authors.affiliation: Institute of Pathology, Bundeswehrkrankenhaus Ulm, 89081 Ulm, Germany.
authors.forename: Konrad
authors.initials: K
authors.lastname: Steinestel
authors.affiliation: Cancer Center, Hannover University Medical School, D-30625 Hannover, Germany.
authors.forename: Gerd
authors.initials: G
authors.lastname: Wegener
authors.affiliation: Department of Urology and Pediatric Urology, Saarland University Medical Center and Saarland University Faculty of Medicine, D-66421 Homburg/Saar, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Siemer
authors.affiliation: Department of Urology, Mainz University Medical Center, D-55101 Mainz, Germany.
authors.forename: Joachim W
authors.initials: JW
authors.lastname: Thüroff
authors.affiliation: Department of Urology, Philipps University of Marburg, D-35037 Marburg, Germany.
authors.forename: Rainer
authors.initials: R
authors.lastname: Hofmann
authors.affiliation: Department of Urology and Pediatric Urology, Saarland University Medical Center and Saarland University Faculty of Medicine, D-66421 Homburg/Saar, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Stöckle
authors.affiliation: Department of Urology, Ulm University Medical Center, D-89075 Ulm, Germany.
authors.forename: Mark
authors.initials: M
authors.lastname: Schrader
authors.affiliation: Institute of Pathology, Erlangen University Medical Center, D-91023 Erlangen, Germany.
authors.forename: Arndt
authors.initials: A
authors.lastname: Hartmann
authors.affiliation: Institute of Pathology, Saarland University Faculty of Medicine, D-66421 Homburg/Saar, Germany.
authors.forename: Andrea
authors.initials: A
authors.lastname: Hasenfus
authors.affiliation: Department of Urology and Urological Oncology, Hannover University Medical School, D-30625 Hannover, Germany.
authors.forename: Markus A
authors.initials: MA
authors.lastname: Kuczyk
authors.affiliation: Department of Urology and Pediatric Urology, Saarland University Medical Center and Saarland University Faculty of Medicine, D-66421 Homburg/Saar, Germany.
authors.forename: Kerstin
authors.initials: K
authors.lastname: Junker
authors.affiliation: Department of Urology, Ulm University Medical Center, D-89075 Ulm, Germany; Department of Urology, Philipps University of Marburg, D-35037 Marburg, Germany.
authors.forename: Andres J
authors.initials: AJ
authors.lastname: Schrader
mesh_terms: D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate
keywords: Chromophobe RCC; Fuhrman nuclear grading system; Histology; Prognosis; Renal cell carcinoma; Survival