Does the Fuhrman or World Health Organization/International Society of Urological Pathology Grading System Apply to the Xp11.2 Translocation Renal Cell Carcinoma?: A 10-Year Single-Center Study.

The Fuhrman and World Health Organization/International Society of Urological Pathology (WHO/ISUP) grading systems are widely used to predict survival for patients with conventional renal cell carcinoma. To determine the validity of nuclear grading systems (both the Fuhrman and the WHO/ISUP) and the individual components of the Fuhrman grading system in predicting the prognosis of Xp11.2 translocation renal cell carcinoma (Xp11.2 tRCC), we identified and followed up 47 patients with Xp11.2 tRCC in our center from January 2007 to June 2017. The Fuhrman and WHO/ISUP grading was reassigned by two pathologists. Nuclear size and shape were determined for each case based on the greatest degree of nuclear pleomorphism using image analysis software. Univariate and multivariate analyses were performed to evaluate the capacity of the grading systems and nuclear parameters to predict overall survival and progression-free survival. On univariate Cox regression analysis, the parameters of nuclear size were associated significantly with overall survival and progression-free survival, 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 associated independently with survival. Our findings indicate that neither the Fuhrman nor the WHO/ISUP grading system is applicable to Xp11.2 tRCC. The assessment of nuclear size instead may be novel outcome predictors for patients with Xp11.2 tRCC.

Preoperative C-reactive protein/albumin ratio predicts outcome of surgical papillary renal cell carcinoma.

Aim: To evaluate the prognostic values of some preoperative inflammation-based factors including C-reactive protein/albumin ratio (CRP/Alb) and platelet level in papillary renal cell carcinoma (PRCC). Materials & methods: A total of 108 PRCC patients underwent partial or radical nephrectomy were retrospectively analyzed. The prognostic values were determined with Kaplan-Meier analysis, univariate and multivariate COX regression models. Results: CRP/Alb and platelet level were both significantly associated with subtype, Fuhrman grade, tumor stage, lymph node invasion, perinephric fat extension, shorter overall survival (OS) and disease-free survival (all p < 0.01). Further, CRP/Alb was an independent prognostic factor for OS (hazard ratio: 9.64, 95% CI: 2.17-23.78; p = 0.003). Conclusion: Relatively higher CRP/Alb independently predicted poorer OS of surgical PRCC patients.

Preoperative neutrophil-to-lymphocyte ratio predicts the surgical outcome of Xp11.2 translocation/TFE3 renal cell carcinoma patients.

BACKGROUND: The preoperative neutrophil-to-lymphocyte ratio (NLR), C-reactive protein/albumin ratio (CRP/Alb ratio) and platelet-to-lymphocyte ratio (PLR) have been demonstrated to predict the clinical outcome of various human cancer, including renal cell carcinoma(RCC). The aim of our study was to explore the prognostic values of these ratios in patients with Xp11.2 translocation/TFE3 gene fusions renal cell carcinoma (Xp11.2 tRCC). METHODS: A retrospective multicentre study was performed in 82 Xp11.2 tRCC patients who underwent radical or partial nephrectomy. The optimal cutoff values of the NLR, CRP/Alb ratio and PLR were determined by the receiver operating characteristic (ROC) analysis. The impact of the NLR, CRP/Alb ratio and PLR, as well as other clinicopathological characteristics, on disease-free survival (DFS) and overall survival (OS) were evaluated using the univariate and multivariate Cox regression analyses. RESULTS: The optimal cutoff values of the NLR, CRP/Alb ratio and PLR were set at 2.45, 140 and 0.08, respectively, according to the ROC analysis. Univariate analyses showed that the NLR, CRP/Alb ratio and PLR all were associated with DFS of Xp11.2 tRCC patients (P < 0.001, P = 0.005 and P = 0.001, respectively) and OS of Xp11.2 tRCC patients (P = 0.016, P = 0.003 and P = 0.014, respectively). Multivariate analysis indicated that the NLR was independently associated with DFS of Xp11.2 tRCC patients (hazard ratio [HR]: 4.25; 95% confidence interval [95% CI]: 1.19-15.18; P = 0.026) along with age (P = 0.004), the pT status (P < 0.001) and the pN status (P < 0.019), and the NLR (HR: 26.26; 95% CI: 1.44-480.3; P = 0.028) also was independently associated with OS in patients with Xp11.2 tRCC, along with age (P = 0.016) and a tumour thrombus (P = 0.007). CONCLUSION: Overall, relatively high NLRs, CRP/Alb ratios and PLRs were associated with a poor prognosis of Xp11.2 tRCC patients; among of them, only the NLR independently predicted the progression of Xp11.2 tRCC, and the NLR may help to identify patients with high metastasis or relapse risk.

Incidence and significance of psammoma bodies in Xp11.2 translocation renal cell carcinoma and papillary renal cell carcinoma.

The aim of the present study was to investigate the incidence and significance of psammoma bodies (PBs) in Xp11.2 translocation renal cell carcinoma (Xp11.2 tRCC) and papillary renal cell carcinoma (PRCC). The presence of PBs, irregular calcifications, hyaline globules and nested architecture in RCC tissues, which included 47 cases of Xp11.2 tRCC and 95 cases of PRCC, was examined by two pathologists. Compared with PRCC, patients with Xp11.2 tRCC exhibited a higher frequency of PBs, hyaline globules and nested architecture. The presence of PBs in combination with the occurrence of a nested architecture achieved a specificity of 93.7% when diagnosing Xp11.2 tRCC. However, there were no significant differences in the overall survival between patients with and without PBs in both types of RCC. Therefore, the presence of PBs combined with nested architecture may provide guidance for the diagnosis of Xp11.2 tRCC; however, PBs cannot predict tumor behavior in Xp11.2 tRCC or PRCC.