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

Ji Yong Ha; Hyuk Soo Chang; Chun Il Kim

doi:10.4111/kju.2007.48.5.471

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Ha, Chang, and Kim: Significance of the Nuclear Grade as a Prognostic Factor for Patients with Localized Renal Cell Carcinoma

Original Article

Korean J Urol 2007;48(5):471-476.

Published online: 18 December 2007

DOI: https://doi.org/10.4111/kju.2007.48.5.471

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

Ji Yong Ha, Hyuk Soo Chang, Chun Il Kim

¹From the Department of Urology, Keimyung University School of Medicine Daegu, Korea

Corresponding author: Kim Cheon-il Keimyung University College of Medicine Dongsan Medical Center Urology 194, Dongsan-dong, Jung-gu, Daegu-si 700-712 TEL: 053-250-7646 FAX: 053-250-7643 E-mail: cikim@dsmc.or.kr

Received 12 January 2007 Accepted 29 March 2007

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose:

I 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:

MMMMs βλ MMkldhl 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:

Infill 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 く 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 く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. I

Keywords: Renal cell carcinoma, Survival rate, Cell nucleus shape

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Fig. 1.

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

Fig. 2.

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

Fig. 3.

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

Fig. 4.

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

Fig. 5.

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

Table 1.

Characteristics of the patients and tumor

Factor	No. of patients
Total No. of patients	172
Sex
Male	104 (60.5%)
Female	68 (39.5%)
Mean age (years)	55.02 ±12.57 (20-83)
Mean tumor size (cm)	5.83 ±2.7(1.8-15.5)
T stage
T1a	50
T1b	67
T2	55
Nuclear grade
I	14
II	95
III	40
IV	23
Microvascular invasion
Negative	162
Positive	10

Table 2.

Survival analysis according to the nuclear grade

Fuhrman grade	No. of patients (%)	Metastasis No. of patients (%)	1 YSR (%)	5 YSR (%)∗	10 YSR (%)
I	14 (8.1)	0 (0)	100	100	100
II	95 (55.2)	5 (5.3)	98.8	86.1	57.1
III	40 (23.3)	8 (20.0)	100	77.8	14.3
IV	23 (13.4)	13 (56.5)	89.5	33.3	6.7
Overall	172 (100.0)	26 (15.1)	97.7	87.2	81.4

∗: p< 0.0001. YSR: year survival rate

Table 3.

Multivariate analysis of the prognostic factors for survival

Variable factor	Relative risk hazard ratio	95% confidence interval		p-value
Variable factor	Relative risk hazard ratio	Lower	Upper	p-value
TNM stage	1.25	0.69	2.28	0.467
Nuclear grade	3.24	1.78	5.88	< 0.001
Microvascular invasion	1.62	0.47	5.59	0.445

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