A Proposal for Reclassification of the Fuhrman Grading System in Patients with Clear Cell Renal Cell Carcinoma
A Proposal for Reclassification of the Fuhrman Grading System in Patients with Clear Cell Renal Cell Carcinoma
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DOI：
10.1016/j.eururo.2009.06.008
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发表时间：
2009-11-01
期刊：
影响因子：
23.4
通讯作者：
Karakiewicz, Pierre I.
中科院分区：
文献类型：
--
作者：
Sun, Maxine;Lughezzani, Giovanni;Karakiewicz, Pierre I.
背景：传统的 Fuhrman 分级系统将肾细胞癌 (RCC) 分为 I、II、III 和 IV 级，是最广泛使用的 RCC 癌症特异性死亡率 (CSM) 预测评估。 目的：本研究的目的是测试依赖于两级或三级分类的简化 Fuhrman 分级方案 (FGS) 的预后能力。 设计、设置和参与者：当前的研究针对以下人群： 1988 年至 2004 年间接受部分或根治性肾切除术治疗的 14 064 名透明细胞肾细胞癌患者，属于九个监测、流行病学和最终结果 (SEER) 癌症登记中心。测量：对各种 FGS 进行单变量和多变量分析以及预后准确性分析，以测试其预测 CSM 率的能力。将传统的四层 FGS 与改进的两层 FGS 进行比较，其中 I 级和 II 级以及 III 级和 IV 级相结合。还测试了第二个简化的三层 FGS，其中将 I 级和 II 级合并，但将 III 级和 IV 级分开。结果和局限性：总体 5 年 CSM 无率为 81.5%。所有三个 FGS 在多变量分析中均达到了独立预测状态。依赖于各种 FGS 的多变量模型的预后准确度对于改进的两层 FGS 为 83.6%，对于传统的四层 FGS 和改进的三层 FGS 均为 83.8%。结论：我们的研究结果表明，简化的 FGS 与传统的四层 FGS 的性能相同。使用简化的分级方案可能对病理学家以及护理 RCC 患者的临床医生来说是一个优势。 Crown 版权所有 (C) 2009 由 Elsevier B.V. 代表欧洲泌尿外科协会出版。版权所有。
Background: The conventional Fuhrman grading system, which categorizes renal cell carcinoma (RCC) with grades I, II, III, and IV, is the most widely used predictor assessment of RCC cancer-specific mortality (CSM).Objectives: The aim of this study was to test the prognostic ability of simplified Fuhrman grading schemes (FGSs) that rely on two- or three-tiered classifications.Design, setting, and participants: The current study addressed a population of 14 064 patients with clear cell RCC who were treated with partial or radical nephrectomy between 1988-2004, within nine Surveillance, Epidemiology, and End Results (SEER) cancer registries.Measurements: Univariable and multivariable analyses as well as prognostic accuracy analyses were performed for various FGSs to test their ability to predict CSM rates. The conventional four-tiered FGS was compared to a modified two- tiered FGS in which grades I and II and grades III and IV were combined. A second simplified three-tiered FGS in which grades I and II were combined but grades III and IV were kept separate was also tested.Results and limitations: The overall 5-yr CSM-free rate was 81.5%. All three FGSs achieved independent predictor status in multivariable analyses. Prognostic accuracy of multivariable models that relied on various FGSs was 83.6% for the modified two- tiered FGS and 83.8% for both the conventional four-tiered and the modified three-tiered FGS.Conclusions: Our findings indicate that the simplified FGSs perform equally as well as the conventional four-tiered FGS. The use of simplified grading schemes may represent an advantage for pathologists as well as for clinicians caring for patients with RCC. Crown Copyright (C) 2009 Published by Elsevier B. V. on behalf of European Association of Urology. All rights reserved.