Multicenter determination of optimal interobserver agreement using the Fuhrman grading system for renal cell carcinoma -: Assessment of 241 patients with > 15-year follow-up
Multicenter determination of optimal interobserver agreement using the Fuhrman grading system for renal cell carcinoma -: Assessment of 241 patients with > 15-year follow-up
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DOI：
10.1002/cncr.20812
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发表时间：
2005-02-01
期刊：
影响因子：
6.2
通讯作者：
Jacqmin, D
中科院分区：
文献类型：
--
作者：
Lang, H;Lindner, W;Jacqmin, D
背景Fuhrman系统是肾细胞癌（RCC）最广泛使用的核分级系统。虽然Fuhrman核分级被广泛接受为一个重要的预后因素，但其可重复性，如文献中有限数量的系列报道，似乎是低的。1980 ~ 1990年，在法国斯特拉斯堡大学医院泌尿科对255例肾癌（pT 1 - 3bN 0 M0）进行了根治性肾切除术。在一项回顾性多中心研究中，3名病理学家根据Fuhrman分级系统对255例病例中的241例进行了独立分类。作者通过将评分系统分为三层方案，然后分为两层方案，来寻找最佳观察者间一致性。此外，根据经典的四层方案和最佳折叠方案生成总生存曲线。kappa指数用于评估每对观察者之间的一致性水平，考克斯模型用于多变量生存分析。平均观察者间K值为0.22（范围：0.09-0.36）。通过将低级别（1-2级）疾病与高级别（3-4级）疾病进行比较，获得了最佳一致性。这样做将平均观察者间K值提高到0.44（范围，0.32-0.55）。Fuhrman分级是所有3位病理学家的独立预后因素（分别为P = 0.01、P < 0.0001和P = 0.004），在进行最佳折叠算法后，核分级仍然具有独立的预后价值（P = 0.004、P = 0.0003和P = 0.005）。Fuhrman分级系统崩溃为两级方案，导致观察者间一致性的改善，同时保留了核分级的独立预后价值。(C)2004年美国癌症协会。
BACKGROUND. The Fuhrman system is the most widely used nuclear grading system for renal cell carcinoma (RCC). Although Fuhrman nuclear grade is widely accepted as a significant prognostic factor, its reproducibility, as reported in the limited number of series available in the literature, appears to be low.METHODS. Between 1980 and 1990, 255 cases of RCC (pT1-3bN0M0) were treated with radical nephrectomy at the Department of Urology, University Hospital, Strasbourg, France. In a retrospective multicenter study, 3 pathologists independently classified 241 of these 255 cases according to the Fuhrman grading system. The authors searched for optimal interobserver agreement by collapsing the grading system to a three-tiered scheme and then to a two-tiered scheme. In addition, overall survival curves were generated according to the classic four-tiered scheme and also according to the best collapsed scheme. The kappa index was used to assess the level of agreement between each pair of observers, and the Cox model was used for multivariate survival analyses.RESULTS. The mean interobserver K value was 0.22 (range, 0.09-0.36). The best concordance was obtained by collapsing to a system in which low-grade (Grade 1-2) disease was compared with high-grade (Grade 3-4) disease. Doing so improved the mean interobserver K value to 0.44 (range, 0.32-0.55). Fuhrman grade was an independent prognostic factor for all 3 pathologists (P = 0.01, P < 0.0001, and P = 0.004, respectively), and nuclear grade continued to have independent prognostic value after the optimal collapsing algorithm was performed (P = 0.004, P = 0.0003, and P = 0.005).CONCLUSIONS. Collapsing of the Fuhrman grading system to a two-tiered scheme led to an improvement in interobserver agreement while preserving the independent prognostic value of nuclear grade. (C) 2004 American Cancer Society.