Comparing World Health Organization/International Society of Urological Pathology Grading and Fuhrman Grading with the Prognostic Value of Nuclear Area in Patients with Renal Cell Carcinoma
Abstract
:1. Introduction
2. Materials and Methods
2.1. Inclusion of Patients
2.2. Evaluation of Pathological Parameters
2.3. Stereological Assessment of Nuclear Area
2.4. Statistics
3. Results
4. Discussion
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Grading System | Grade 1 | Grade 2 | Grade 3 | Grade 4 |
---|---|---|---|---|
Fuhrman | Small (≈10 μm) round uniform nuclei with absent or inconspicuous nucleoli | Larger (≈15 μm) nuclei with irregularities in outline and with nucleoli visible at ×400 magnification | Even larger nuclei (≈20 μm) with an obvious irregular outline and nucleoli visible at ×100 magnification | Cells large, pleomorphic with bizarre multilobed giant cells and heavy chromatin clumps, extreme irregular outlines |
WHO/ISUP | Absent or basophilic, inconspicuous nucleoli at ×400 magnification | Nucleoli conspicuous and eosinophilic at ×400 magnification and visible, but not prominent at ×100 magnification | Nucleoli conspicuous and eosinophilic at ×100 magnification | Rhabdoid or sarcomatous differentiation, tumor giant cells and extreme nuclear pleomorphism with clumping of chromatin |
Delahunt [4] | ISUP G1 with/without necrosis and ISUP G2 without necrosis | ISUP G2 with necrosis and ISUP G3 without necrosis | ISUP G3 with necrosis and ISUP G4 without necrosis | ISUP G4 with necrosis or sarcomatoid/rhabdoid features |
Mean (SD) Variable | N (%) | MNA µm2 (SD) | p-Value | MNA-10 µm2 (SD) | p-Value |
---|---|---|---|---|---|
Sex * | |||||
Male | 75 (60) | 42.9 (13.8) | 0.8 | 80.3 (27.1) | 0.7 |
Female | 49 (40) | 42.2 (16.2) | 82.1 (35.1) | ||
Histology ** | |||||
ccRCC | 101 (81) | 41.7 (15.2) | 0.06 | 80.9 (32.2) | 0.38 |
Papillary type 1 | 14 (11) | 42.3 (10.3) | 74.7 (19.9) | ||
Papillary type 2 | 9 (8) | 53.8(11.42) | 92.6 (18.8) | ||
Stage ** | |||||
pT1 | 57 (46) | 39.2 (13.7) | 0.1 | 73.4 (26.7) | 0.07 |
pT2 | 22 (18) | 44.8 (12.9) | 87.2 (26.3) | ||
pT3 | 40 (33) | 46.4 (16.6) | 87.1 (33.8) | ||
pT4 | 4 (3) | 45.0 (14.8) | 95.0 (52.8) | ||
Necrosis * | |||||
Absent | 79 | 37.6 (10.9) | <0.0001 | 69.6 (19.9) | <0.0001 |
Present | 45 | 51.6 (16.4) | 100.9 (35.3) |
Grading Systems | WHO/ISUP | Total | |||
---|---|---|---|---|---|
Fuhrman | 1 | 2 | 3 | 4 | |
1 | 5 | 0 | 0 | 0 | 5 |
2 | 21 | 38 | 2 | 0 | 61 |
3 | 0 | 9 | 34 | 0 | 43 |
4 | 0 | 0 | 1 | 14 | 15 |
Total | 26 | 47 | 37 | 14 |
Models | Groups | AUC-ROC (95% CI) | Harrell’s C-index (95% CI) |
---|---|---|---|
MNA | MNA low vs high | 0.71 (0.62–0.82) | 0.7 (0.62–0.79) |
WHO/ISUP | G1-G4 | 0.75 (0.66–0.84) | 0.74 (0.66–0.83) |
Fuhrman | G1-G4 | 0.68 (0.57–0.79) | 0.68 (0.58–0.79) |
Novel Models | |||
MNA and tumor necrosis | |||
Grade 1 | MNA low/no necrosis | 0.8 (0.72–0.88) | 0.76 (0.68–0.83) |
Grade 2 | MNA low/with necrosis | ||
Grade 3 | MNA high/no necrosis | ||
Grade 4 | MNA high/with necrosis | ||
Delahunt modified groups [4] | |||
Grade 1 | ISUP G1/no necrosis | 0.76 (0.65–0.86) | 0.75 (0.66–0.85) |
ISUP G1/with necrosis | |||
ISUP G2/no necrosis | |||
Grade 2 | ISUP G2/ with necrosis | ||
ISUP G3/ no necrosis | |||
Grade 3 | ISUP G3/ with necrosis | ||
ISUP G4/no necrosis | |||
Grade 4 | ISUP G4/ with necrosis or sarkomatoid differentiation |
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Rabjerg, M.; Gerke, O.; Engvad, B.; Marcussen, N. Comparing World Health Organization/International Society of Urological Pathology Grading and Fuhrman Grading with the Prognostic Value of Nuclear Area in Patients with Renal Cell Carcinoma. Uro 2021, 1, 2-13. https://doi.org/10.3390/uro1010002
Rabjerg M, Gerke O, Engvad B, Marcussen N. Comparing World Health Organization/International Society of Urological Pathology Grading and Fuhrman Grading with the Prognostic Value of Nuclear Area in Patients with Renal Cell Carcinoma. Uro. 2021; 1(1):2-13. https://doi.org/10.3390/uro1010002
Chicago/Turabian StyleRabjerg, Maj, Oke Gerke, Birte Engvad, and Niels Marcussen. 2021. "Comparing World Health Organization/International Society of Urological Pathology Grading and Fuhrman Grading with the Prognostic Value of Nuclear Area in Patients with Renal Cell Carcinoma" Uro 1, no. 1: 2-13. https://doi.org/10.3390/uro1010002