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Can Renal Mass Biopsy Assessment of Tumor Grade be Safely Substituted for by a Predictive Model?

2009; Lippincott Williams & Wilkins; Volume: 182; Issue: 6 Linguagem: Inglês

10.1016/j.juro.2009.08.053

1527-3792

Claudio Jeldres, Maxine Sun, Daniel Liberman, Giovanni Lughezzani, Alexandre de la Taille, Jacques Tostain, Antoine Valéri, Luca Cindolo, Vincenzo Ficarra, Walter Artibani, Richard Zigeuner, Arnaud Méjean, Jean Luc Descotes, É. Lechevallier, Peter F.A. Mulders, Paul Perrotte, Jean‐Jacques Patard, Pierre I. Karakiewicz,

Cancer Genomics and Diagnostics

No AccessJournal of UrologyAdult Urology1 Dec 2009Can Renal Mass Biopsy Assessment of Tumor Grade be Safely Substituted for by a Predictive Model? Claudio Jeldres, Maxine Sun, Daniel Liberman, Giovanni Lughezzani, Alexandre de la Taille, Jacques Tostain, Antoine Valeri, Luca Cindolo, Vincenzo Ficarra, Walter Artibani, Richard Zigeuner, Arnaud Mejean, Jean Luc Descotes, Eric Lechevallier, Peter F. Mulders, Paul Perrotte, Jean-Jacques Patard, and Pierre I. Karakiewicz Claudio JeldresClaudio Jeldres Department of Urology, University of Montreal, Montreal, Quebec, Canada , Maxine SunMaxine Sun Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada , Daniel LibermanDaniel Liberman Department of Urology, University of Montreal, Montreal, Quebec, Canada , Giovanni LughezzaniGiovanni Lughezzani Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada Department of Urology, Vita-Salute San Raffaele, Milan, Italy , Alexandre de la TailleAlexandre de la Taille Department of Urology, Lille University Hospital, Lille, France , Jacques TostainJacques Tostain Department of Urology, Lille University Hospital, Lille, France , Antoine ValeriAntoine Valeri Department of Urology, Lille University Hospital, Lille, France , Luca CindoloLuca Cindolo Department of Urology, Vita-Salute San Raffaele, Milan, Italy , Vincenzo FicarraVincenzo Ficarra Department of Urology, Vita-Salute San Raffaele, Milan, Italy , Walter ArtibaniWalter Artibani Department of Urology, Vita-Salute San Raffaele, Milan, Italy , Richard ZigeunerRichard Zigeuner Department of Urology, Lille University Hospital, Lille, France Department of Urology, Medical University of Graz, Graz, Austria , Arnaud MejeanArnaud Mejean Department of Urology, Lille University Hospital, Lille, France , Jean Luc DescotesJean Luc Descotes Department of Urology, Lille University Hospital, Lille, France , Eric LechevallierEric Lechevallier Department of Urology, Lille University Hospital, Lille, France , Peter F. MuldersPeter F. Mulders Department of Urology, Lille University Hospital, Lille, France , Paul PerrottePaul Perrotte Department of Urology, University of Montreal, Montreal, Quebec, Canada , Jean-Jacques PatardJean-Jacques Patard Department of Urology, Lille University Hospital, Lille, France , and Pierre I. KarakiewiczPierre I. Karakiewicz Department of Urology, University of Montreal, Montreal, Quebec, Canada View All Author Informationhttps://doi.org/10.1016/j.juro.2009.08.053AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Fuhrman grade represents a key determinant of the natural history of small renal masses that represent renal cell carcinoma. We tested whether renal mass biopsy prediction of Fuhrman grade in the nephrectomy specimen could be safely substituted for by an accurate statistical model. To date the best available model has shown poor accuracy (55.6%), which is close to flipping a coin (50%) and clearly inadequate for use in clinical practice. Materials and Methods: We identified 1,139 patients with T1aN0M0 renal cell carcinoma treated with partial or radical nephrectomy at 11 participating institutions from 1989 to 2004. This cohort was used in univariate and multivariate logistic regression models predicting high Fuhrman grade (III–IV) at nephrectomy. Predictors included age at diagnosis, gender, tumor size and symptom classification. Multivariate logistic regression coefficients were used to generate a nomogram. Results: The rate of Fuhrman grade III–IV in patients with T1aN0M0 renal cell carcinoma was 12.3%. Stratifying patients with Fuhrman grade III–IV by age, gender, histological subtypes and sample size failed to reveal statistically significant differences. On univariate analysis predicting Fuhrman grade III–IV at nephrectomy only tumor size was a statistically significant predictor (p = 0.05). The most accurate multivariate nomogram for Fuhrman grade III–IV prediction was 58.3% (95% CI 57.8–58.9) accurate. Of all tested predictors only tumor size achieved independent predictor status (p = 0.009). Conclusions: Our analysis derived in European patients shows that statistical models cannot safely replace renal mass biopsy based prediction of Fuhrman grade III–IV at nephrectomy. Our findings corroborate a report from the United States in which a similar model had 55.6% accuracy. Jointly the studies indicate that statistical models are unreliable and cannot safely be substituted for renal mass biopsy in North American or European patients. References 1 : Clinicians are poor raters of life-expectancy before radical prostatectomy or definitive radiotherapy for localized prostate cancer. BJU Int2007; 100: 1254. Google Scholar 2 : Prognostic significance of morphologic parameters in renal cell carcinoma. Am J Surg Pathol1982; 6: 655. Crossref, Medline, Google Scholar 3 : Prognostic ability of simplified nuclear grading of renal cell carcinoma. Cancer2007; 109: 868. Google Scholar 4 : An outcome prediction model for patients with clear cell renal cell carcinoma treated with radical nephrectomy based on tumor stage, size, grade and necrosis: the SSIGN score. J Urol2002; 168: 2395. Link, Google Scholar 5 : Risk group assessment and clinical outcome algorithm to predict the natural history of patients with surgically resected renal cell carcinoma. J Clin Oncol2002; 20: 4559. Google Scholar 6 : Fine-needle percutaneous biopsy of renal masses with helical CT guidance. Radiology2000; 216: 506. Crossref, Medline, Google Scholar 7 : Percutaneous core biopsy for renal masses: indications, accuracy and results. J Urol2007; 178: 1184. Link, Google Scholar 8 : The accuracy of 250 fine needle biopsies of renal tumors. J Urol2005; 174: 44. Link, Google Scholar 9 : Accuracy and clinical role of fine needle percutaneous biopsy with computerized tomography guidance of small (less than 4.0 cm) renal masses. J Urol2004; 171: 1802. Link, Google Scholar 10 : Prognostic value of histologic subtypes in renal cell carcinoma: a multicenter experience. J Clin Oncol2005; 23: 2763. Google Scholar 11 : Collecting duct renal cell carcinoma: a matched analysis of 41 cases. Eur Urol2007; 52: 1140. Google Scholar 12 : Unclassified renal cell carcinoma: an analysis of 85 cases. BJU Int2007; 100: 802. Google Scholar 13 : NCCN clinical practice guidelines in oncology: kidney cancer. JNCCN2009; 7: 618. Google Scholar 14 : Review of minimally invasive renal therapies: needle-based and extracorporeal. Urology2006; 68: 26. Google Scholar 15 : Solid renal tumors: an analysis of pathological features related to tumor size. J Urol2003; 170: 2217. Link, Google Scholar 16 : Renal mass biopsy—a renaissance?. J Urol2008; 179: 20. Link, Google Scholar 17 : A preoperative prognostic nomogram for solid enhancing renal tumors 7 cm or less amenable to partial nephrectomy. J Urol2007; 178: 429. Link, Google Scholar 18 : Grading systems in renal cell carcinoma. J Urol2007; 177: 430. Google Scholar 19 : Multicenter determination of optimal interobserver agreement using the Fuhrman grading system for renal cell carcinoma: Assessment of 241 patients with > 15-year follow-up. Cancer2005; 103: 625. Google Scholar 20 : Original and reviewed nuclear grading according to the Fuhrman system: a multivariate analysis of 388 patients with conventional renal cell carcinoma. Cancer2005; 103: 68. Google Scholar 21 : Interobserver and intraobserver variability using the Fuhrman grading system for renal cell carcinoma. Arch Pathol Lab Med2003; 127: 593. Google Scholar 22 : Radical versus partial nephrectomy: effect on overall and noncancer mortality. Cancer2009; 115: 1465. Google Scholar 23 : Partial versus radical nephrectomy in patients with adverse clinical or pathologic characteristics. Urology2009; 73: 1300. Google Scholar 24 : Accuracy of percutaneous core biopsy in management of small renal masses. Urology2009; 73: 586. Google Scholar © 2009 by American Urological AssociationFiguresReferencesRelatedDetailsCited byLaguna M (2020) Re: Renal Mass Biopsy is Associated with Reduction in Surgery for Early-Stage Kidney CancerJournal of Urology, VOL. 203, NO. 5, (878-878), Online publication date: 1-May-2020.Millet I, Curros F, Serre I, Taourel P and Thuret R (2012) Can Renal Biopsy Accurately Predict Histological Subtype and Fuhrman Grade of Renal Cell Carcinoma?Journal of Urology, VOL. 188, NO. 5, (1690-1694), Online publication date: 1-Nov-2012.Wang H, Zhu Y, Yao X, Zhang S, Dai B, Zhang H, Shen Y, Wang C and Ye D (2012) External Validation of a Nomogram Using RENAL Nephrometry Score to Predict High Grade Renal Cell CarcinomaJournal of Urology, VOL. 187, NO. 5, (1555-1560), Online publication date: 1-May-2012. Volume 182Issue 6December 2009Page: 2585-2589 Advertisement Copyright & Permissions© 2009 by American Urological AssociationKeywordsEuropebiopsykidneyrenal cellstatisticalmodelscarcinomaMetricsAuthor Information Claudio Jeldres Department of Urology, University of Montreal, Montreal, Quebec, Canada More articles by this author Maxine Sun Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada More articles by this author Daniel Liberman Department of Urology, University of Montreal, Montreal, Quebec, Canada More articles by this author Giovanni Lughezzani Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada Department of Urology, Vita-Salute San Raffaele, Milan, Italy More articles by this author Alexandre de la Taille Department of Urology, Lille University Hospital, Lille, France More articles by this author Jacques Tostain Department of Urology, Lille University Hospital, Lille, France More articles by this author Antoine Valeri Department of Urology, Lille University Hospital, Lille, France More articles by this author Luca Cindolo Department of Urology, Vita-Salute San Raffaele, Milan, Italy More articles by this author Vincenzo Ficarra Department of Urology, Vita-Salute San Raffaele, Milan, Italy More articles by this author Walter Artibani Department of Urology, Vita-Salute San Raffaele, Milan, Italy More articles by this author Richard Zigeuner Department of Urology, Lille University Hospital, Lille, France Department of Urology, Medical University of Graz, Graz, Austria More articles by this author Arnaud Mejean Department of Urology, Lille University Hospital, Lille, France More articles by this author Jean Luc Descotes Department of Urology, Lille University Hospital, Lille, France More articles by this author Eric Lechevallier Department of Urology, Lille University Hospital, Lille, France More articles by this author Peter F. Mulders Department of Urology, Lille University Hospital, Lille, France More articles by this author Paul Perrotte Department of Urology, University of Montreal, Montreal, Quebec, Canada More articles by this author Jean-Jacques Patard Department of Urology, Lille University Hospital, Lille, France More articles by this author Pierre I. Karakiewicz Department of Urology, University of Montreal, Montreal, Quebec, Canada More articles by this author Expand All Advertisement PDF downloadLoading ...