Premium
Percentage of high‐grade carcinoma as a prognostic indicator in patients with renal cell carcinoma
Author(s) -
Serrano Maria F.,
Katz Matthew,
Yan Yan,
Kibel Adam S.,
Humphrey Peter A.
Publication year - 2008
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.23574
Subject(s) - medicine , renal cell carcinoma , nephrectomy , grading (engineering) , carcinoma , stage (stratigraphy) , kidney cancer , t stage , proportional hazards model , survival analysis , oncology , pathology , cancer , urology , kidney , paleontology , civil engineering , engineering , biology
BACKGROUND. The prognostic value of Fuhrman nuclear grade for patients with renal cell carcinoma has been well‐characterized. However, to the authors' knowledge, the prognostic significance of the amount of high‐grade renal cell carcinoma has not been previously analyzed. METHODS. The authors identified 898 consecutive renal cell carcinoma cases treated with nephrectomy between 1989 and 2003. Histopathologic features that were captured based on re‐review of all slides included histologic type, pathologic stage, conventional Fuhrman grade, and percentage of Fuhrman grade 3 and 4 carcinoma, as ascertained by visual inspection of histologic slides. The clinical endpoints were metastasis‐free survival, cancer‐specific survival, and overall survival. RESULTS. Kaplan‐Meier analysis demonstrated that both conventional Fuhrman grading and the percentage of Fuhrman grade 3 and 4 carcinoma were highly correlated with all 3 measures of patient survival ( P < .0001). The creation of 3 categories of the percentage of Fuhrman grade 3 and 4 carcinoma (0%, 1–50%, and 51–100%) generated distinctly separate survival curves. On Cox proportional hazards multivariate analysis, TNM stage, tumor size, and the percentage of Fuhrman grade 3 and 4 carcinoma were all found to be significantly associated with all 3 types of patient survival (all P values <.05). CONCLUSIONS. The determination of the percentage of renal cell carcinoma that is 0%, 1% to 50%, or 51% to 100% high Fuhrman grade 3 and 4 is a simple and powerful measurement of patient outcome after surgery that provides additional prognostic information beyond stage, tumor size, and conventional Fuhrman grade. This prognostic information could be useful in the stratification of patients into prognostic groups for the development of more individualized follow‐upschedules and for enrollment into clinical trials. Cancer 2008. © 2008 American Cancer Society.