The Relationship of Fuhrman Nuclear Grade, Tumor Stage and Sarcomatoid Differentiation with Survival in Renal Cell Carcinomas

Abstract

Objective: Renal cell carcinoma derived from tubular epithelium is one of the malignant tumors of the kidney. We have investigated the histological features, pathological stage, nuclear grade and sarcomatoid differentiation of these tumors. Material and Methods: Histological slides from seventy-eight nephrectomy specimens diagnosed as renal cell carcinoma between 2000 and 2008 were reevaluated according to the 2004 World Health Organization classification system of kidney tumors. Reclassified cases were collected in five groups and were scored for Fuhrman nuclear grading, stage, sarcomatoid differentiation and survival rate. Results: In our study, cases with high nuclear grade, advanced stage and sarcomatoid differentiation revealed poor survival rates (p<0.05). In conclusion, the correlation between prognostic histopathological parameters and survival rates was consistent with literature findings. Conclusion: Fuhrman nuclear grading, stage and sarcomatoid differentiation are important parameters and are related factors in survival when investigating renal cell carcinomas. Fuhrman nuclear grading must be evaluated correctly and the highest grade should be reported. Although there aren't enough studies about sarcomatoid differentiation, its presence significantly decreases survival rates. It is very important to state histopathological parameters including sarcomatoid differentiation precisely on the pathology report. Turkish Başlık: Renal Hücreli Karsinomlarda Fuhrman Nükleer Derece, Evre ve Sarkomatoid Diferansiyasyonun Sağkalım İle İlişkisi Anahtar Kelime: Renal hücreli karsinom, Prognoz, Anjiyogenez Amaç: Renal hücreli karsinom, böbrek tubul epitelinden kaynaklanan malign bir tümördür. Çalışmamızda bu tümörlerin histolojik özellikleri, boyutu, evrelendirme, nükleer derecelendirme ve sarkomatoid diferansiyasyon parametreleri ile sağkalım arasındaki ilişki araştırıldı. Hastalar ve Yöntemler: 2000-2008 yılları arasında renal hücreli karsinom tanısı almış 78 nefrektomi olgusu 2004 Dünya Sağlık Örgütü sınıflamasına göre yeniden değerlendirildi. Beş histolojik alt tipte sınıflandırılan olguların Fuhrman Nükleer Dereceleri, evreleri, sarkomatoid diferansiyasyon varlığı ve sağkalım oranları kaydedildi. Tüm parametrelerin birbirleriyle ilişkileri istatistiksel yöntemlerle değerlendirildi. Bulgular: Çalışmamızda yüksek nükleer derece, ileri evre ve sarkomatoid diferansiyasyon gösteren olgularda sağkalım süreleri kısaydı (p<0,05). Sonuç olarak, renal hücreli karsinomlarda prognostik değeri olan histopatolojik parametreler ile sağkalım arasında literatürle uyumlu olarak anlamlı ilişki saptandı. Sonuç: Renal Hücreli Karsinomların değerlendirilmesinde kullanılan Fuhrman nükleer dereceleme, evre ve sarkomatoid diferansiyasyon sağkalım ile ilişkili önemli parametrelerdir. Fuhrman nükleer derecelemenin mutlaka doğru yapılması ve tumor içinde izlenen en yüksek derecenin raporlanması uygundur. Literatürde çok sayıda çalışma yapılmamış olmakla birlikte tümörde sarkomatoid diferansiyasyon varlığı sağkalım oranlarını anlamlı ölçüde azaltmaktadır. Sarcomatoid diferansiasyonu da içeren histopatolojic parametrelerin doğru değerlendirilmesi ve patoloji raporunda bildirilmesi çok önemlidir.

Keywords

• Renal cell carcinoma, prognosis, angiogenesis

The Relationship of Fuhrman Nuclear Grade, Tumor Stage and Sarcomatoid Differentiation with Survival in Renal Cell Carcinomas

Öz

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