Department of Urology, Seoul National University College of Medicine, Seoul, Korea.
BJU Int. 2011 Feb;107(3):409-15. doi: 10.1111/j.1464-410X.2010.09561.x. Epub 2010 Aug 26.
To investigate the efficacy of simplified (two- or three-tiered) Fuhrman grading systems as prognostic indicators in clear-cell renal cell carcinoma (RCC).
By reviewing records, various clinicopathological factors were assessed in 431 patients who received surgical management for clear-cell RCC. A conventional four-tiered Fuhrman grading system was compared with a modified two-tiered grading system (Fuhrman grades I and II were combined as one class, and grades III and IV as another) and also with a three-tiered grading system (only grades I and II were combined). Efficacies of grading systems were assessed via univariate analyses and multivariate models for prediction of cancer-specific survival.
In univariate analysis, the four-tiered and three-tiered grading systems showed similar accuracies (76.5 vs 76.2%, P =0.614) for predicting cancer-specific survival, which were greater than that of the two-tiered system (72.5%; both P < 0.05). Of the three grading systems, only the three-tiered system was an independent predictor of cancer-specific survival in multivariate analysis (P = 0.046). When receiver operating characteristic-derived areas under the curve (AUCs) of multivariate models for predicting cancer-specific survivals were assessed, AUCs for models including the three-tiered Fuhrman grading system and the conventional four-tiered Fuhrman grading system were the same (95.3%), followed by that of a model incorporating the two-tiered grading system (95.1%).
A modified, three-tiered Fuhrman grading system can be considered an appropriate option in the application of a nuclear grading system to the prognostication of clear-cell RCC in both univariate analysis and multivariate model setting.
研究简化（两或三级）富尔曼分级系统作为预测透明细胞肾细胞癌（RCC）预后指标的疗效。
通过回顾病历，对 431 例接受透明细胞 RCC 手术治疗的患者评估了各种临床病理因素。将传统的四级富尔曼分级系统与改良的两分级系统（富尔曼 1 级和 2 级合并为 1 类，3 级和 4 级合并为另 1 类）和三级分级系统（仅 1 级和 2 级合并）进行比较。通过单变量分析和多变量模型评估分级系统的疗效，以预测癌症特异性生存。
在单变量分析中，四级和三级分级系统在预测癌症特异性生存方面的准确性相似（76.5%对 76.2%，P=0.614），均大于两分级系统（72.5%；均 P<0.05）。在这三种分级系统中，只有三级系统是多变量分析中癌症特异性生存的独立预测因子（P=0.046）。当评估用于预测癌症特异性生存的多变量模型的接收者操作特征曲线（AUC）下面积时，包括三级富尔曼分级系统和传统四级富尔曼分级系统的模型的 AUC 相同（95.3%），其次是纳入两分级系统的模型（95.1%）。
在单变量分析和多变量模型设置中，改良的三级富尔曼分级系统可作为核分级系统在预测透明细胞 RCC 预后中的一种合适选择。
