Department of Urology, Tokai University School of Medicine, Isehara, Kanagawa 259-1193, Japan.
Department of Pathology, Tokai University School of Medicine, Isehara, Kanagawa 259-1193, Japan.
Int J Oncol. 2018 Apr;52(4):1139-1148. doi: 10.3892/ijo.2018.4294. Epub 2018 Feb 28.
The aim of the present study was to evaluate the validity of potential prognostic parameters of clear cell renal cell carcinoma (ccRCC) recommended by the 2012 International Society of Urological Pathology (ISUP) Consensus Conference in the Japanese population. We reviewed 406 Japanese patients with localized or locally advanced ccRCC who underwent curative surgery during 2004-2014 at Tokai University Hospital (Isehara, Japan) and were followed up for >2 years after surgery. A single pathologist reviewed all the histological slides. Morphological subtype and pathological T stage were reassigned according to the 2016 World Health Organization and TNM classifications. Sarcomatoid differentiation (SD), rhabdoid differentiation (RD), tumor necrosis (TN) and microvascular invasion (MVI) were assessed according to the 2012 ISUP recommendations. Nuclear grade was reclassified according to both the Fuhrman and the ISUP grading systems. Recurrence‑free survival (RFS) and cancer-specific survival (CSS) were assessed through univariate and multivariate analyses. According to the Fuhrman grading system (group Fuhrman), TN and MVI were independent risk factors for postoperative recurrence in the multivariate analysis using the Cox proportional hazards model. According to the ISUP grading system (group ISUP), TN and MVI were independent risk factors for postoperative recurrence. In group Fuhrman, age, Fuhrman grade and TN were independent risk factors for CSS. In group ISUP, age, ISUP grade, and TN were independent risk factors for CSS. Furthermore, the group that was upgraded from Fuhrman grade 2 to ISUP grade 3 exhibited poorer CSS compared with the group that was reclassified from Fuhrman grade 2 to ISUP grade 2 (non-upgraded). Regardless of the nuclear grade, TN remained an independent predictor of RFS and CSS. To the best of our knowledge, this is the first report to prove the correlation between the 2012 ISUP recommendations and clinical outcomes in a Japanese ccRCC cohort. TN and upgrading to ISUP grade 3 were found to be potentially useful independent indicators of postoperative prognosis.
本研究旨在评估 2012 年国际泌尿病理学会（ISUP）共识会议推荐的用于预测透明细胞肾细胞癌（ccRCC）患者预后的潜在参数在日本人群中的有效性。我们回顾了 2004 年至 2014 年期间在日本东海大学医院（Isehara）接受根治性手术且术后随访时间>2 年的 406 例局限性或局部进展性 ccRCC 日本患者。由一位病理学家对所有组织学切片进行了复查。形态学亚型和病理 T 分期根据 2016 年世界卫生组织和 TNM 分类进行重新分期。肉瘤样分化（SD）、横纹肌样分化（RD）、肿瘤坏死（TN）和微血管侵犯（MVI）根据 2012 年 ISUP 建议进行评估。核分级根据 Fuhrman 和 ISUP 分级系统进行重新分类。通过单因素和多因素分析评估无复发生存率（RFS）和癌症特异性生存率（CSS）。根据 Fuhrman 分级系统（Fuhrman 组），TN 和 MVI 是多因素 Cox 比例风险模型分析中术后复发的独立危险因素。根据 ISUP 分级系统（ISUP 组），TN 和 MVI 是术后复发的独立危险因素。在 Fuhrman 组中，年龄、Fuhrman 分级和 TN 是 CSS 的独立危险因素。在 ISUP 组中，年龄、ISUP 分级和 TN 是 CSS 的独立危险因素。此外，从 Fuhrman 分级 2 升级到 ISUP 分级 3 的患者与重新分类为 Fuhrman 分级 2 的患者相比，CSS 较差（未升级）。无论核分级如何，TN 仍然是 RFS 和 CSS 的独立预测因子。据我们所知，这是第一项证明 2012 年 ISUP 建议与日本 ccRCC 队列临床结局之间相关性的报告。TN 和升级到 ISUP 分级 3 被发现是术后预后的潜在有用的独立指标。
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