Samaratunga Hemamali, Gianduzzo Troy, Delahunt Brett
Aquesta Pathology, Brisbane, Queensland, Australia; University of Queensland, Brisbane, Queensland, Australia; Wesley Hospital, Brisbane, Queensland, Australia; Department of Pathology and Molecular Medicine, Wellington School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand.
J Kidney Cancer VHL. 2014 Jul 20;1(3):26-39. doi: 10.15586/jkcvhl.2014.11. eCollection 2014.
There have been significant changes in the staging, classification and grading of renal cell neoplasia in recent times. Major changes have occurred in our understanding of extra-renal extension by renal cell cancer and how gross specimens must be handled to optimally display extra-renal spread. Since the 1981 World Health Organization (WHO) classification of renal tumors, in which only a handful of different entities were reported, many new morphological types have been described in the literature, resulting in 50 different entities reported in the 2004 WHO classification. Since 2004, further new entities have been recognized and reported necessitating an update of the renal tumor classification. There have also been numerous grading systems for renal cell carcinoma with Fuhrman grading, the most widely used system. In recent times, the prognostic value and the applicability of the Fuhrman grading system in practice has been shown to be, at best, suboptimal. To address these issues and to recommend reporting guidelines, the International Society of Urological Pathology (ISUP) undertook a review of adult renal neoplasia through an international consensus conference in Vancouver in 2012. The conduct of the conference was based upon evidence from the literature and the current practice amongst recognized experts in the field. Working groups selected to deal with key topics evaluated current data and identified points of controversy. A pre-meeting survey of the ISUP membership was followed by the consensus conference at which a formal ballot was taken on each key issue. A 65% majority vote was taken as consensus. This review summarizes the outcome and recommendations of this conference with regards to staging, classification and grading of renal cell neoplasia.
近年来，肾细胞肿瘤的分期、分类和分级发生了重大变化。我们对肾细胞癌肾外扩展的理解以及如何处理大体标本以最佳显示肾外扩散方面发生了重大变化。自1981年世界卫生组织（WHO）对肾肿瘤进行分类（当时仅报告了少数几种不同类型）以来，文献中描述了许多新的形态学类型，导致2004年WHO分类中报告了50种不同类型。自2004年以来，又识别并报告了更多新类型，因此有必要更新肾肿瘤分类。肾细胞癌也有众多分级系统，其中Fuhrman分级是使用最广泛的系统。近年来，Fuhrman分级系统在实际应用中的预后价值和适用性已被证明充其量只是次优的。为了解决这些问题并推荐报告指南，国际泌尿病理学会（ISUP）于2012年在温哥华通过一次国际共识会议对成人肾肿瘤进行了综述。该会议依据文献证据和该领域公认专家的当前实践开展。被选来处理关键主题的工作组评估了当前数据并确定了争议点。在ISUP成员的会前调查之后召开了共识会议，会上对每个关键问题进行了正式投票。以65%的多数票作为达成共识的标准。本综述总结了此次会议关于肾细胞肿瘤分期、分类和分级的结果及建议。
