1984 Volume 75 Issue 10 Pages 1637-1645
A clinico-pathological study was performed in 154 patients with renal cell carcinoma experienced during the 14-year-period from 1969-1982.
The prognosis was correlated with the clinical stage based on Robson's classification and in particular with pathological features such as cell type, structural pattern and nuclear morphologic grade (NMG) as well. By modifying Skinner's grading system, NMG was divided into four subgroups (grade 1 to 4) depending on the differences in nuclear size, oral shape, irregularity, chromatin pattern and nucleoli prominence.
Results:
1) The 5-year survival rates were 68.0%, 64.9%, 34.9% and 6.2% for stages I, II, III and IV, respectively. The survival rates and stages were significantly correlated as a whole but the difference between stage I and II was not statistically significant.
2) Neither cell type nor structural pattern has no relevance to survival, while mixture of spindle cell and sarcomatoid pattern was definitely a poor prognostic sign.
3) The 5-year survival rates were 80.4%, 71.5%, 33.1% and 7.9% for grades 1, 2, 3 and 4, respectively. As with the stages, there was a significant correlation between the survival rates and grade, although simplified classification by high grade (3 and 4) and low (grade 1 and 2) system is also indicative of poor and favorable prognosis, respectively.
4) Stages and grades were correlated well in such a way that lower stage tumors were comprised mainly of lower grade ones and vice versa. Although both are of prognostic value in assessing the patients as a group, grades were more indicative of individual prognosis, since death with low stage tumors was found only in patients with high grade tumors and most long term survivors with high stage tumor demonstrated low grade tumor.
5) MNG was more valuable than the other pathological findings in predicting the subsequent course of patints following nephrectomy, when combined with clinical stage.
