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

Kaynakça

1. Chow WH, Devesa SS, Warren JL, Fraumeni JF Jr. Rising incidence of renal cell cancer in the United States. JAMA 1999;281:1628- 31. [CrossRef]
2. Lohse CM, Cheville JC. A review of prognostic pathologic fea- tures and algorithms for patients treated surgically for renal cell carcinoma. Clin Lab Med 2005;25:433-64. [CrossRef]
3. Eble JN, Togashi K, Pisani P. Renal cell carcinoma. In: Eble JN, Sauter G, Epstein JI, Sesterhenn IA (Eds.) Pathology and genetics of tumors of the urinary system and male genital organs. World Health organization classification of tumors. Lyon: IARC Press; 2004.p.10-14
4. Fuhrman SA, Lasky LC, Limas C. Prognostic significance of mor- phologic parameters in renal cell carcinoma. Am J Surg Pathol 1982;6:655-63. [CrossRef]
5. Green F, Page D, Fleming L. AJCC cancer staging manual. 6th ed. New York: Springer; 2002.
6. Kim HL, Belldegrun AS, Freitas DG, Bui MH, Han KR, Dorey FJ, et al. Paraneoplastic signs and symptoms of renal cell carcinoma: im- plications for prognosis. J Urol Nov 2003;170:1742-6. [CrossRef]
7. Amin MB, Amin MB, Tamboli P, Javidan J, Stricker H, de-Peralta Venturina M, et al. Prognostic impact of histologic subtyping of adult renal epithelial neoplasms: an experience of 405 cases. Am J Surg Pathol 2002;26:281-91. [CrossRef]
8. Jayson M, Sanders H. Increased incidence of serendipitously dis- covered renal cell carcinoma. Urology 1998;51:203-5. [CrossRef]

9. Cheville JC, Lohse CM, Zincke H, Weaver AL, Blute ML. Com- parisons of outcome and prognostic features among histologic subtypes of renal cell carcinoma. Am J Surg Pathol 2003;27:612- 24. [CrossRef]
10. Patard JJ, Leray E, Rioux-Leclercq N, Cindolo L, Ficarra V, Zisman A, et al. Prognostic value of histologic subtypes in renal cell carcinoma: a multicenter experience. J Clin Oncol 2005;23:2763-71. [CrossRef]
11. Robson CJ, Churchill BM, Anderson W. The results of radical ne- phrectomy for renal cell carcinoma. J Urol 1969;101:297-301.
12. Lang H, Jacqmin D. Prognostic factors in renal cell carcinoma. EAU Update Series 2003;1:215-9. [CrossRef]
13. Delahunt B, Sika-Paotonu D, Bethwaite PB, McCredie MR, Martignoni G, Eble JN, et al. Fuhrman grading is not appropri- ate for chromophobe renal cell carcinoma. Am J Surg Pathol 2007;31:957-60. [CrossRef]
14. Giulliani L, Giberti C, Martorana G, Rovida S. Radical extensive surgery for renal cell carcinoma: long term results and prognostic factors. J Urol 1990;143:468-74.
15. Skinner DG, Colvin RB, Vermillion CD, Pfister RC, Leadbetter WF. Diagnosis and management of renal cell carcinoma. A clinical and pathologic study of 309 cases. Cancer 1971;28:1165-77. [CrossRef]
16. Kontak JA, Campbell SC. Prognostic factors in renal cell carci- noma. Urol Clin North Am 2003;30:467-80. [CrossRef]
17. Sika-Paotonu D, Bethwaite PB, McCredie MR, William Jordan T, Delahunt B. Nucleolar grade but not Fuhrman grade is applicable to papillary renal cell carcinoma. Am J Surg Pathol 2006;30:1091- 6. [CrossRef]
18. Kus E, Yıldız K, Dillioğlogil O. Correlation between Fuhrman Nu- clear grade and stage with survival in Renal Cell Carcinoma. Turk J Path 2009;25:71-7. [CrossRef]
19. Gelb AB, Shibuya RB, Weiss LM, Medeiros LJ. Stage I renal cell carcinoma. A clinicopathologic study of 82 cases. Am J Surg Pathol 1993;17:275-86. [Cross-Ref]
20. Goldstein NS. Grading of renal cell carcinoma. Urol Clin North Am 1999;26:637-42. [CrossRef]
21. Ro JY, Ayala AG, Sella A, Samuels ML, Swanson DA. Sarcomatoid renal cell carcinoma: clinicopathologic study of 42 cases. Cancer 1987;59:516-26. [CrossRef]
22. De Peralta-Venturina M, Moch H, Amin M, Tamboli P, Hailemari- am S, Mihatsch M, et al. Sarcomatoid differentiation in renal cell carcinoma: a study of 101 cases. Am J Surg Pathol 2001;25:275- 84. [CrossRef]