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. 2018 Apr;52(4):1139-1148.
doi: 10.3892/ijo.2018.4294. Epub 2018 Feb 28.

Verification of the International Society of Urological Pathology recommendations in Japanese patients with clear cell renal cell carcinoma

Hakushi Kim  1 , Chie Inomoto  2 , Takato Uchida  1 , Hiroyuki Furuya  3 , Tomoyoshi Komiyama  4 , Hiroshi Kajiwara  2 , Hiroyuki Kobayashi  4 , Naoya Nakamura  2 , Akira Miyajima  1
Affiliations

Verification of the International Society of Urological Pathology recommendations in Japanese patients with clear cell renal cell carcinoma

Hakushi Kim et al. Int J Oncol. 2018 Apr.

Abstract

The aim of the present study was to evaluate the validity of potential prognostic parameters of clear cell renal cell carcinoma (ccRCC) recommended by the 2012 International Society of Urological Pathology (ISUP) Consensus Conference in the Japanese population. We reviewed 406 Japanese patients with localized or locally advanced ccRCC who underwent curative surgery during 2004-2014 at Tokai University Hospital (Isehara, Japan) and were followed up for >2 years after surgery. A single pathologist reviewed all the histological slides. Morphological subtype and pathological T stage were reassigned according to the 2016 World Health Organization and TNM classifications. Sarcomatoid differentiation (SD), rhabdoid differentiation (RD), tumor necrosis (TN) and microvascular invasion (MVI) were assessed according to the 2012 ISUP recommendations. Nuclear grade was reclassified according to both the Fuhrman and the ISUP grading systems. Recurrence‑free survival (RFS) and cancer-specific survival (CSS) were assessed through univariate and multivariate analyses. According to the Fuhrman grading system (group Fuhrman), TN and MVI were independent risk factors for postoperative recurrence in the multivariate analysis using the Cox proportional hazards model. According to the ISUP grading system (group ISUP), TN and MVI were independent risk factors for postoperative recurrence. In group Fuhrman, age, Fuhrman grade and TN were independent risk factors for CSS. In group ISUP, age, ISUP grade, and TN were independent risk factors for CSS. Furthermore, the group that was upgraded from Fuhrman grade 2 to ISUP grade 3 exhibited poorer CSS compared with the group that was reclassified from Fuhrman grade 2 to ISUP grade 2 (non-upgraded). Regardless of the nuclear grade, TN remained an independent predictor of RFS and CSS. To the best of our knowledge, this is the first report to prove the correlation between the 2012 ISUP recommendations and clinical outcomes in a Japanese ccRCC cohort. TN and upgrading to ISUP grade 3 were found to be potentially useful independent indicators of postoperative prognosis.

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Conflict of interest statement

Competing interests

The authors declare that they have no competing interests.

Figures

Figure 1
Figure 1
Photomicrograph of coagulative tumor necrosis. (a) Example of coagulative tumor necrosis (CTN) adjacent to eosinophilic tumor cells (H&E staining; magnification, ×20). (b) Histopathological slide showing ischemic necrosis, which should be distinguished from CTN (H&E staining; magnification, ×20). H&E, hematoxylin and eosin.
Figure 2
Figure 2
Photomicrograph of microvascular invasion. (a) Renal cell carcinoma (RCC) is seen protruding into the vessel (hematoxylin and eosin staining; magnification, ×20). (b) The tumor cells broke through the vessel collagen wall and invaded into the vessel (arrows). Elastica Van Gieson staining; magnification, ×20.
Figure 3
Figure 3
(a) RFS and (b) CSS following curative surgery for tumors classified as Fuhrman grade 1/2 (red line) vs. Fuhrman grade 3/4 (blue line). (c) RFS and (d) CSS following curative surgery for tumors classified as ISUP grade 1/2 (red line) vs. ISUP grade 3/4 (blue line). RFS, recurrence-free survival; CSS, cancer-specific survival; ISUP, International Society of Urological Pathology.
Figure 3
Figure 3
(a) RFS and (b) CSS following curative surgery for tumors classified as Fuhrman grade 1/2 (red line) vs. Fuhrman grade 3/4 (blue line). (c) RFS and (d) CSS following curative surgery for tumors classified as ISUP grade 1/2 (red line) vs. ISUP grade 3/4 (blue line). RFS, recurrence-free survival; CSS, cancer-specific survival; ISUP, International Society of Urological Pathology.
Figure 4
Figure 4
(a) RFS and (b) CSS following curative surgery for tumors without TN (red line) vs. those with TN (blue line). (c) RFS and (d) CSS following curative surgery for tumors without MVI (red line) vs. those with MVI (blue line). RFS, recurrence-free survival; CSS, cancer-specific survival; TN, tumor necrosis; MVI, microvascular invasion.
Figure 4
Figure 4
(a) RFS and (b) CSS following curative surgery for tumors without TN (red line) vs. those with TN (blue line). (c) RFS and (d) CSS following curative surgery for tumors without MVI (red line) vs. those with MVI (blue line). RFS, recurrence-free survival; CSS, cancer-specific survival; TN, tumor necrosis; MVI, microvascular invasion.
Figure 5
Figure 5
(a) RFS and (b) CSS following curative surgery for tumors classified from Fuhrman grade 2 to ISUP grade 2 (red line) vs. those upgraded from Fuhrman grade 2 to ISUP grade 3 (blue line). RFS, recurrence-free survival; CSS, cancer-specific survival; ISUP, International Society of Urological Pathology.
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