Abstract
Renal cell carcinoma (RCC) with a high-nucleolar-grade component is considered to be an aggressive type of tumor. In the present study, we evaluated the impact of the presence of the worst-nucleolar-grade component and also tried to determine predictors for recurrence and prognosis in patients with the worst grade component. We evaluated 314 patients with RCC. A three-graded system was used for nucleolar grading, the patients were classified into four groups according to the presence of the worst nucleolar grade (Grade 3) and the occupancy of each grade, and clinicopathological factors and clinical outcomes were compared. In patients of Grade 3 components (Groups 1 and 2), factors influencing on prognosis and recurrence were evaluated by multivariate analysis. There was no significant difference in clinicopathological factors between Group 1 (with Grade 3-dominant tumors) and Group 2 (with tumors in which Grade 1 or 2 was dominant and there were Grade 3 components). Neither did cause-specific survival or recurrence-free survival differ significantly between those two groups. In multivariate analysis, only distant metastasis was an independent predictor for prognosis in all patients with Grade 3 components. Moreover, an elevated C-reactive protein (CRP) level (>or=1 mg/dl) was the only independent predictor of recurrence in N0M0 patients. Regardless of dominancy, the presence of the worst grade component has a significant clinical impact in RCC patients. N0M0 patients whose RCC has worst-grade components but whose CRP levels are <1 are expected to have longer recurrence-free intervals and to survive longer than those whose CRP levels are higher.
Highlights
Nucleolar grade generally reflects a biological activity of cancer cell and the aggressiveness of a tumor and is associated with the prognosis of patients with renal cell carcinoma (RCC) (1 – 3)
The C-reactive protein (CRP) levels might seem to differ between those two groups, the difference is not statistically significant (P 1⁄4 0.0561)
These results suggest that Groups 1 and 2 were similar populations with regard to their clinicopathological characters and their recurrence and prognosis
Summary
Nucleolar grade generally reflects a biological activity of cancer cell and the aggressiveness of a tumor and is associated with the prognosis of patients with renal cell carcinoma (RCC) (1 – 3). A recent study evaluating 1801 RCC patients treated with radical nephrectomy found histological grade (Fuhrman nuclear grade), TNM stage, tumor size 5 cm and histological tumor necrosis to be independent predictors for cancer-specific survival [3]. The patients with a worst-grade tumor (Grade 4) had a risk rate for cancer-. Nucleolar grade is reportedly an independent predictor for cause-specific survival [3] and patients with high-grade tumors have a higher risk for recurrence than do patients with low-grade tumors [4], a significant amount of patients with high-grade components in the primary tumor have an excellent prognosis. It is clinically important to identify factors that have a significant impact on recurrence and prognosis in RCC patients with the worst-nucleolargrade component
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