| Backgrounds:Nnuclear grading is one of the methods to reflect tumor cell differentiation and heteromorphism,and an ideal nuclear grading system should be able to reflect degree of malignancy and assist in predicting tumor behavior.Since proposed by Fuhrman in 1982,Fuhrman grading has been widely used all over the world.Despite its popularity,criterias of Fuhrman grading system are somewhat intricate,subjective,and inhomogenous.Besides,the prognosis of each grades was not obvious.In this way,various improved or simplified greeding systems were rising up,such as the two-tiered grading system of Zisman and three-tiered grading system of Ficarra.Compared with Fuhrman grading system,none of the improved or simplified greeding systems made a great breakthrough or received widely used.After surveyed views of pathologists,the International Society of Urological Pathology(ISUP)Consensus Conference proposed a novel grading system in 2012,which abandon the subjective aspects in assessing the nuclear size.Then,this grading system was accepted by the World Health Organization(WHO)in 2016.However,abovementioned grading system justed be recommended for applying to clear cell renal renal cell carcinoma(ccRCC)and papillary renal cell carcinoma(pRCC)but no others renal cell carcinoma(RCC)tyeps,such as chromophobe renal cell carcinoma(cRCC).As a rare subtype of renal cell carcinoma,Xp11.2 translocation renal cell carcinoma(Xp11.2 tRCC)possess special pathological feature and poor prognosis.So far,there is few experience of the application of nuclear grading systems to Xp11.2 tRCC.Objections:To determine the validity of nuclear grading systems in predicting the prognosis of Xp11.2 translocation renal cell carcinoma.Methods:Between January 2007 to June 2017,47 cases of Xp11.2 tRCC were identified by polyclonal break-apart probes for TFE3 gene rearrangement in Nanjing Drum Tower hospital.All HE sections were reviewed by two dedicated pathologists and the Fuhrman,Zisma,Ficarra and WHO/ISUP grading was assigned subjuctively.What's more,Nuclear size and shape were determined for each case based on the greatest degree of nuclear pleomorphism using image analysis software.Measurements of nuclear size were recorded as:nuclear perimeter,nuclear area and length of major nuclear axis.Measurements of nuclear size were recorded as:shape factor and nuclear compactness.Univariate and multivariate analyses were performed to evaluate the capacity of the grading systems and the employment of the nuclear parameters to predict overall survival(OS)and progression-free survival(PFS).Results:Of the 47 cases,20(42.6%)cases were male and 27(57.4%)cases were female with a mean age of 31 years(range of 3-71 years).For Fuhrman grading system,1(2.1%)case was marked as grade 1,25(53.2%)cases grade 2,18(38.3%)cases grade 3 and 3(6.4%)case grade 4.Division of cases based on WHO/ISUP grading resulted in grade 1 for 2(5.3%)cases,grade 2 for 12(26.3%)cases,grade 3 for 29(61.7%)cases and grade 4 for 4(8.5%)cases.Average nuclear area,length of major nuclear axis nuclear perimeter were 31.84(6.6-58.7)?m2,7.72(5.30-10.20)?m,and 21.82(14.70-30.10)?m respectively.Average shape factor and nuclear compactness were 0.83(0.71-0.97)and 15.23(12.94-17.73),respectively.During following up,two patients were lost for follow-up after operation.For the remaining 45 cases,the duration of follow-up ranged from 1 to 114 months with a median time of 37 months.On univariate Cox regression analysis,the parameters of nuclear size were significantly associated with OS and PFS,whereas the grading systems and the parameters of nuclear shape failed to reach a significant correlation.On multivariate analysis,however,none of the parameters was independently associated with survival.Conclusions:Our findings indicate that neither the Fuhrman nor the WHO/ISUP grading system is applicable to Xp 11.2 tRCC.The assessment of nuclear size may instead be novel outcome predictors for patients with Xp11.2 tRCC. |
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