Comparative Analysis Of WHO/ISUP And Fuhrman Grading In 219 Cases Of Clear Cell Renal Cell Carcinoma And Correlate Evaluation Study Of Prognostic Factors

Objectives:To compare the similarities and differences between WHO/ISUP grading and Fuhrman grading in 219 cases of clear cell Renal Cell Carcinoma(ccRCC),and to evaluate the correlation between the two gradings and the prognostic factors of clear cell Renal Cell Carcinoma(ccRCC),and to verify its clinical application value.Methods:We retrospectively collected the records of clinical and pathological data of 219 patients with clear cell Renal Cell Carcinoma(ccRCC)were diagnosed at the department of pathology,the Second Affiliated Hospital of Kunming Medical University between January 1,2010 and June 30,2017,all slides were reviewed by WHO/ISUP grading and Fuhrman grading respectively.Using Wilcoxon rank sum test to exam the difference between WHO/ISUP grading and Fuhrman grading,Kappa test was used to detect the consistency of WHO/ISUP grading and Fuhrman grading.Using Wilcoxon rank sum test and correlation analysis to exam the differences in composition of gender,the average grading of gender,the difference in composition and the correlation of pT staging,operation method,tumor site,the average value of the intravascular cancer suppository.Using analysis of variance to exam the difference in composition of average grading of pT staging.Using single factor analysis of variance and correlation analysis to exam the difference in composition and the correlation of tumor size,and the difference in composition of average grading of tumor size,with P<0.05 for the difference is statistically significant,rs>0 for the positive correlation.All data were assessed with SPSS22.0.Results:1.Basic clicinal features of clear cell Renal Cell Carcinoma(ccRCC):of all the219 cases,152(69.4%)were male and 67(30.6%)were female.Average age was 48 ±13.33 years old,ranged from 24-84 years old.161(73.5%)cases with laparoscopic radical nephrectomy and 58(26.5%)cases with laparoscopic partial nephrectomy.The tumors located in the left kidney were 102(46.6%)cases and located in the right kidney were 117(53.4%)cases.2.Pathological features of clear cell Renal Cell Carcinoma(ccRCC):Tumor size varied from 1.5 to 13cm,with a mean size of 4.0 ± 1.93cm.Tumor stage was determined according to the 2009 AJCC TNM classication of malignant tumors.There were 116,77,13,1,1,10 in pT1a,pT1b,pT2a,pT2b,pT3a,pT3b and pT4,10(4.6%)patients with intravascular cancer suppository and 209(95.4%)patients with no intravascular cancer suppository.The distribution of WHO/ISUP grading for all the patients was grade 1-55,grade 2-104,grade 3-54,grade 4-6.There were 70,115,28 and 6 cases in Fuhrman grade 1,2,3 and 4 respectively.3.Statistical results:① Wilcoxon rank sum test result showed that there was a distinction in 1-3 WHO/ISUP grading and Fuhrman grading(P<0.001).The Kappa test result showed that a high consistency appeared between WHO/ISUP grading and Fuhrman grading(0.61<Kappa<0.80).②Wilcoxon rank sum test result showed that gender composition was statistically significant in WHO/ISUP grading(P=0.03)and was not in Fuhrman gradingP=0.11).The average grading in WHO/ISUP grading and Fuhrman grading of male patients and female patients was statistically significant(P=0.035 and P=0.043).The average grading of male and female patients in WHO/ISUP grading and Fuhrman grading was also statistically significant(P=0.023 and P=0.029),the proportion of patients with high grading was higher in males.③The difference in composition of pT staging was statistically significant in WHO/ISUP grading and Fuhrman grading(P=0.001 and P=0.004).Analysis of variance results showed that the difference of the average grading of pT3+pT4 staging was higher than the average grading of pTl and pT2 staging in WHO/ISUP grading and Fuhrman grading,with the result was statistically significant(P<0.001 and P<0.001).④ The difference in composition of operation method and tumor site was not statistically significant in WHO/ISUP grading and Fuhrman grading(P=0.951 and P=0.647,P=0.543and P=0.93).⑤The average value of with or without intravascular cancer suppository was statistically significant in WHO/ISUP grading and Fuhrman grading(P=0.04 and P=0.03),patients with intravascular cancer suppository had a higher grading.⑥Correlation analysis results showed that pT staging and the average value of with or without intravascular cancer suppository have a positive correlation with WHO/ISUP grading and Fuhrman grading(rs=0.274 and rs=0.248,rs=0.222 and rs=0.224).Tumor size has a positive correlation with WHO/ISUP grading(rs=0.174).⑦Single factor analysis of variance results showed that tumor size was statistically significant in WHO/ISUP grading and was not in Fuhrman grading(P=0.001 and P=0.393).In WHO/ISUP grading,there was no statistical significant in grade 1 and grade 2(P=0.073),there was statistical signigicant between grade 3 and grade 1,2(P=0.005).Conclusions:1.There is a high consistency between WHO/ISUP grading and Fuhrman grading,WHO/ISUP grading improves the low level grading cases in Fuhrman grading.2.The male patients have a higher level grade than the female patients in WHO/ISUP grading and Fuhrman grading,and have a higher risk of disease.3.Tumor size,tumor staging and intravascular cancer suppository have better consistency and relevance in WHO/ISUP grading.4.Simplified WHO/ISUP grading will replace Fuhrman grading for the pathological grading of clear cell Renal Cell Carcinoma(ccRCC).