Fuhrman Grade Provides Higher Prognostic Accuracy Than Nucleolar Grade for Papillary Renal Cell Carcinoma

Klatte, Tobias; Anterasian, Christine; Said, Jonathan W.; de Martino, Michela; Kabbinavar, Fairooz F.; Belldegrun, Arie S.; Pantuck, Allan J.

doi:10.1016/j.juro.2010.02.023

« Previous Next »The Journal of Urology
Volume 183, Issue 6 , Pages 2143-2147, June 2010

Fuhrman Grade Provides Higher Prognostic Accuracy Than Nucleolar Grade for Papillary Renal Cell Carcinoma

Tobias Klatte
- Department of Urology, University of California-Los Angeles, Los Angeles, California
Christine Anterasian
- Department of Urology, University of California-Los Angeles, Los Angeles, California
Jonathan W. Said
- Department of Urology, University of California-Los Angeles, Los Angeles, California
- Department of Pathology and Laboratory Medicine, University of California-Los Angeles, Los Angeles, California
Michela de Martino
- Department of Urology, University of California-Los Angeles, Los Angeles, California
Fairooz F. Kabbinavar
- Department of Urology, University of California-Los Angeles, Los Angeles, California
- Department of Medicine, University of California-Los Angeles, Los Angeles, California
Arie S. Belldegrun
- Department of Urology, University of California-Los Angeles, Los Angeles, California
Allan J. Pantuck
- Department of Urology, University of California-Los Angeles, Los Angeles, California
- Correspondence: Department of Urology, David Geffen School of Medicine at University of California-Los Angeles, 10833 Le Conte Ave., Room B7-298A CHS, Los Angeles, California 90025-1738 (telephone: 310-206-2436; FAX: 310-794-3513)

Received 8 October 2009 published online 16 April 2010.

Purpose

Recent evidence suggests that nucleolar grade but not Fuhrman grade is applicable to papillary renal cell carcinoma. We tested this hypothesis in an independent large series from a single institution.

Materials and Methods

One dedicated uropathologist regraded 158 cases of papillary renal cell carcinoma by nucleolar and Fuhrman grades. The prognostic value and predictive accuracy of these grading systems to predict disease specific survival were analyzed by Cox proportional hazards models and the concordance index.

Results

There were 39 papillary renal cell carcinoma related deaths (25%) at a mean followup of 50 months. On univariate analysis nucleolar grade predicted disease specific survival with a concordance index of 67.8% but the survival difference between grades 1 and 2 did not attain statistical significance (p = 0.1441). Fuhrman grade predicted disease specific survival significantly better (concordance index 74.7%, p <0.001). Comparison of survival estimates between the grades revealed statistical significance across each grade category (each p <0.05). Fuhrman but not nucleolar grade was retained as an independent prognostic factor on multivariate analysis (p = 0.027 and 0.128, respectively).

Conclusions

Each grading system performs well but the predictive accuracy of Fuhrman grade is statistically superior to that of nucleolar grade and only Fuhrman grade provides independent prognostic information on patients with papillary renal cell carcinoma. Thus, Fuhrman grade should be the standard grading system for papillary renal cell carcinoma.

Key Words: kidney, carcinoma, renal cell, prognosis, mortality, kidney neoplasms

Abbreviations and Acronyms: DSS, disease specific survival, ECOG PS, Eastern Cooperative Oncology Group performance status, PRCC, papillary renal cell carcinoma, RCC, renal cell carcinoma