Title: Assessing the Prognostic Significance of Fuhrman Grading in Renal Cell Carcinoma by Comparing with Morphological Prognostic Factors
Authors: Vissa Shanthi M.D, Nandam Mohan Rao, M.D, Byna Syam Sundara Rao, M.D, Bhavana Grandhi, M.D, Muram Reddy Vijaya Lakshmi, M.D
DOI: http://dx.doi.org/10.18535/jmscr/v3i10.11
Back ground – Renal cell carcinoma is a disease of varying prognosis. We evaluated the prognostic significance of Fuhrman nuclear grade by comparing with various morphological parameters which are considered to be independent prognostic factors in determining the patient outcome. Materials and methods – Retrospective and prospective study was conducted on patients who underwent nephrectomy during the period of January 2010 to June 2015. 128 cases of nephrectomies were studied out of which 32 cases had renal cell carcinomas which were studied in detail. Fuhrman grade of these tumors were compared with various morphological prognostic factors like tumor subtype the tumor size, tumor multicentricity, presence of sarcomatoid differentiation, necrosis, perinephric fat infiltration, lymph node metastasis, distant metastasis and vascular invasion by tumor. Results – Out of 128 cases of nephrectomies, 32 cases had renal cell carcinomas. Male predominance was noted (68.75%) in these cases. Fuhrman grade in these tumors were found to have correlation with prognostic factors like tumor stage, tumor size, presence of tumor necrosis, perinephric fat infiltration, vascular embolization, lymphnode metastasis. No significant correlation was found between the tumor grade and multicentricity. Conclusion – Fuhrman nuclear grading is considered to be independent prognostic factor in renal cell carcinomas which determines the patient outcome. Keywords: kidney tumors, Fuhrman grade, prognostic factors. 1. Jemal A, Siegal R, Ward E, Hao Y, Xu J, Thun MJ: Cancer statistics, 2009.CA Cancer J Clin.2009;59:225-49. 2. Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin. 2005;55:74-108. 3. Marroncle M, Irani J, Dore B, Levillain P, Goujon JM, Aubert J. Prognostic value of histological grade and nuclear grade in renal adenocarcinoma. J Urol 1994;151:1174-6. 4. Denis Bretheau, Eric Leche Vallier, Marc de Fromont, Marie-Christine Sault, Mariur Ramphal, Christian Coulange. Prognostic value of nuclear grade of renal cell carcinoma. Cancer 1995;vol 76,No:12,2543-2549. 5. Medeiros LJ, Jones EC, Aizawa S, et al. Grading of renal cell carcinoma. Workgroup no.2. Cancer 1997;80:990-991. 6. Grignon DJ, Ayala AG, el-Naggar A et al. Renal cell carcinoma. A clinicopathological and DNA flow cytometric analysis of 103 cases.Cancer 1989;64(10):2133-40. 7. Lang H, Linder V, de Fromont Molinie V, Letourneux H, Meyer N, Martin M, Jacqmin D. multicentre determination of optimal interobserver agreement using the Fuhrman grading system for renal cell carcinoma: Assessment of 241 patients with >-15 year follow up. Cancer 2005;10:625-629. 8. Ficarra V, Martignoni G, Maffei N, Brunelli M, Novara G, Zanolla L, Pea M, Artibani N. Original and reviewed nuclear grading according to the Fuhrman system: a multivariate analysis of 388 patients with conventional renal cell carcinoma. Cancer 2005;103:68-75. 9. Zisman A, Pantuck AJ, DoreyF et al. Improved prognostication of renal cell carcinoma using an integrated staging system. J Clin Oncol 2001;19(6):1649-57. 10. Sun M, Lughezzani G, Jeldres C, et al. A proposal for reclassification of the Fuhrman grading system in patients with clear cell renal cell carcinoma. Eur Urol 2009;52(5):775-81. 11. Rioux –Leclercq N, Karakiewicz Pl, Trinh QD, Ficarra V, Cindolo L, de la Taille A, Tostain J, Zigeuner R, Mejean A, Patard JJ. Prognostic ability of simplified nuclear grading of renal cell carcinoma. Cancer 2007;109:868-874.Abstract
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