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Application of simplified Fuhrman grading system in clear‐cell renal cell carcinoma
Author(s) -
Hong Sung K.,
Jeong Chang W.,
Park Ji H.,
Kim Hyung S.,
Kwak Cheol,
Choe Gheeyoung,
Kim Hyeon H.,
Lee Sang E.
Publication year - 2011
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2010.09561.x
Subject(s) - grading (engineering) , renal cell carcinoma , univariate analysis , clear cell renal cell carcinoma , univariate , kidney cancer , medicine , multivariate analysis , oncology , radiology , computer science , multivariate statistics , biology , machine learning , ecology
Study Type – Prognosis (case series)
Level of Evidence 4 What’s known on the subject? and What does the study add? Previously, some have suggested that the four‐tiered conventional Fuhrman grading system for clear cell renal cell carcinoma is unnecessarily complex. To ease the process of grading, simplified (two‐ or three‐tiered) versions of conventional Fuhrman grading system have been proposed in the literature. Our results showed that the three‐tiered Fuhrman grading system can be considered as an appropriate option in the application of a nuclear grading system to the prognostication of clear cell renal cell carcinoma. OBJECTIVE To investigate the efficacy of simplified (two‐ or three‐tiered) Fuhrman grading systems as prognostic indicators in clear‐cell renal cell carcinoma (RCC). PATIENTS AND 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%). CONCLUSION 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.