Korean J Urol.  2007 May;48(5):471-476. 10.4111/kju.2007.48.5.471.

Significance of the Nuclear Grade as a Prognostic Factor for Patients with Localized Renal Cell Carcinoma

• Ha JY
• Chang HS
• Kim CI

• KMID: 2061249
• DOI: http://doi.org/10.4111/kju.2007.48.5.471

Abstract

PURPOSE: As the number of patients with localized renal cell carcinoma has increased, there are conflicting reports on the nuclear grade as a prognostic factor. The aim of this study was to evaluate the significance of the nuclear grade as a prognostic factor.
MATERIALS AND METHODS
We retrospectively enrolled 172 patients with localized renal cell carcinoma and who underwent radical nephrectomy. The patients were staged according to the 1997 TNM stage and the Fuhrman grading. The survival rate was analyzed by the Kaplan-Meier method. Multivariate analysis was performed using the Cox proportional hazard model.
RESULTS
The overall 1- , 5- and 10-year survival rates were 98.1, 72.5 and 68.4%, respectively. The 5-year survival rates for grades I, II, III and IV were 100, 92.6, 85.0 and 60.9%, respectively (p<0.0001). According to the Fuhrman grade in each T stage, 1) for patients with pT1b, the 5-year survival rates were 100, 85.0, 85.71 and 33.3% for patients with grade I, II, III and IV, respectively (p=0.002). 2) for patients with pT2, the 5-year survival rates were 100, 92.3, 60.0 and 25.0% for patients with grade I, II, III and IV, respectively (p<0.0001). A comparison of the survival curves by the Fuhrman grade showed a statistically significant difference.
CONCLUSIONS
The Fuhrman grade is an important prognostic factor for patients with localized renal cell carcinoma. A high nuclear grade tends to have metastatic potential and a poor prognosis. This group of patients with a high nuclear grade must be followed up more closely. Determining the pathologic stage along with using the Fuhrman grade-based surveillance protocols are a logical approach to follow-up.

Keyword

Renal cell carcinoma; Survival rate; Cell nucleus shape

MeSH Terms

Carcinoma, Renal Cell*
Cell Nucleus Shape
Follow-Up Studies
Humans
Logic
Multivariate Analysis
Nephrectomy
Prognosis
Proportional Hazards Models
Retrospective Studies
Survival Rate

Figure

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  Fig. 1. Kaplan-Meier cancer survival curves according to the T stage. p=0.6093.

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  Fig. 2. Kaplan-Meier cancer survival curves according to micro- vascular invasion. p=0.003.

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  Fig. 3. Kaplan-Meier cancer survival curves according to the Nuclear grade. p <0.001.

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  Fig. 4. Kaplan-Meier cancer survival curves according to the Nuclear grade with T1b. p=0.002.

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  Fig. 5. Kaplan-Meier cancer survival curves according to the nuclear grade with T2. p< 0.0001.

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