A Novel Tumor Grading Scheme for Chromophobe Renal Cell Carcinoma Prognostic Utility and Comparison With Fuhrman Nuclear Grade
A Novel Tumor Grading Scheme for Chromophobe Renal Cell Carcinoma Prognostic Utility and Comparison With Fuhrman Nuclear Grade
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DOI：
10.1097/pas.0b013e3181e96f2a
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发表时间：
2010-09-01
影响因子：
5.6
通讯作者：
Lyles, Robert H.
中科院分区：
文献类型：
--
作者：
Paner, Gladell P.;Amin, Mahul B.;Lyles, Robert H.
肾嫌色细胞癌是肾细胞癌的一种组织学亚型，预后良好。Fuhrman细胞核分级对肾嫌色细胞癌的预后是否有用尚有争议。不规则的细胞核，突出的核仁，和核多形性固有地存在于嫌色细胞RCC。因此，Fuhrman细胞核分级较高，尽管大多数肿瘤的结局良好。在这项研究中，将一种新的3层肿瘤分级系统的预后效用与Fuhrman核分级进行比较，其中嫌色细胞RCC的先天核小体被打折，本文称为来自一系列124个嫌色细胞RCC的嫌色细胞肿瘤分级。嫌色细胞肿瘤分级是基于地理核拥挤和间变性的评估。肿瘤之间的Fuhrman核分级分布为1级（1%）、2级（19%）、3级（74%）和4级（6%），而嫌色细胞肿瘤分级分布为1级（74%）、2级（16%）和3级（10%）。Fuhrman核分级和嫌色细胞肿瘤分级与患者的年龄、性别和嫌色细胞RCC细胞类型均无显著相关性，但均与肿瘤大小显著相关。Fuhrman核分级和嫌色细胞肿瘤分级均与广泛肺泡生长、坏死、血管浸润和病理分期呈统计学显着正相关;然而，所有这些相关性往往取决于具有肉瘤样变化的肿瘤。当排除肉瘤样改变的肿瘤时，嫌色细胞肿瘤分级和病理分期之间存在强正相关。相反，在非肉瘤样嫌色细胞RCC中，Fuhrman核分级和分期之间没有这种关联。从手术到首次发生转移、局部复发或因疾病死亡的时间，描述具有侵袭性行为的侵袭性嫌色细胞RCC，我们发现Fuhrman核分级和嫌色细胞肿瘤分级与不良结局高度相关。然而，与病理分期一样，在非肉瘤样嫌色细胞RCC中，嫌色细胞肿瘤分级与预后之间仅存在显著相关性。多变量考克斯回归分析也倾向于支持嫌色细胞肿瘤分级而不是Fuhrman核分级作为不良结局的独立预测因子，控制了其他单因素显著风险因素[估计相对危险度= 3.68（P = 0.026）vs. 1.86（P = 0.42）]。总之，本文提出的新的嫌色细胞肿瘤分级系统提供了上级的预后价值，在嫌色细胞RCC的Fuhrman核分级，并将潜在地帮助分层嫌色细胞RCC的患者谁是在一个更大的疾病进展的风险。
Chromophobe renal cell carcinoma (RCC) is a histologic subtype of RCC that portends a favorable prognosis. It is controversial whether the Fuhrman nuclear grade of chromophobe RCC has prognostic utility. Irregular nuclei, prominent nucleoli, and nuclear pleomorphism are inherently present in chromophobe RCC. Hence, the Fuhrman nuclear grade is higher even though the majority of these tumors have a favorable outcome. In this study, the prognostic utility of a novel 3-tiered tumor grading system in which the innate nuclear atypia of chromophobe RCC was discounted, herein referred to as chromophobe tumor grade from a series of 124 chromophobe RCC, was compared with Fuhrman nuclear grade. Chromophobe tumor grade is based on the assessment of geographic nuclear crowding and anaplasia. The Fuhrman nuclear grade distribution between the tumors was grade 1 (1%), grade 2 (19%), grade 3 (74%), and grade 4 (6%), whereas the chromophobe tumor grade distribution was grade 1 (74%), grade 2 (16%), and grade 3 (10%). Neither Fuhrman nuclear grade nor chromophobe tumor grade was significantly associated with patient's age or sex and chromophobe RCC cell types, but both showed a significant association with tumor size. Both Fuhrman nuclear grade and chromophobe tumor grade showed statistically significant positive associations with broad alveolar growth, necrosis, vascular invasion, and with pathologic stage; however, all these associations tended to be dictated by tumors with sarcomatoid change. When tumors with sarcomatoid change were excluded, a strong positive association persisted between chromophobe tumor grade and pathologic stage. In contrast, there was no such association between Fuhrman nuclear grade and stage in nonsarcomatoid chromophobe RCCs. Characterizing aggressive chromophobe RCC with aggressive behavior with the time from surgery to first occurrence of metastasis, local recurrence, or death owing to disease, we found that both Fuhrman nuclear grade and chromophobe tumor grade were highly associated with adverse outcome. However, as with the pathologic stage, only a significant association between chromophobe tumor grade and outcome was retained among nonsarcomatoid chromophobe RCCs. Multivariable Cox regression analysis also tended to support chromophobe tumor grade rather than Fuhrman nuclear grade as an independent predictor of adverse outcome, controlling for other univariably significant risk factors [estimated relative hazard = 3.68 (P = 0.026) vs. 1.86 (P = 0.42)]. In conclusion, the novel chromophobe tumor grading system proposed herewith provides superior prognostic value to that of the Fuhrman nuclear grade in chromophobe RCC and will potentially help stratify patients of chromophobe RCC who are at a greater risk of disease progression.