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Reclassification of the Fuhrman grading system in renal cell carcinoma-does it make a difference?

Tahir Qayyum1*, Peter McArdle2, Clare Orange3, Morag Seywright3, Paul Horgan4, Grenville Oades2, Michael Aitchison2 and Joanne Edwards1

Author Affiliations

1 Unit of Experimental Therapeutics, Institute of Cancer, College of MVLS, University of Glasgow, Western Infirmary, Glasgow G11 6NT, Scotland, UK

2 Department of Urology, Gartnaval General Hospital, Glasgow, Scotland, UK

3 Department of Pathology, Western Infirmary, Glasgow, Scotland, UK

4 School of Medicine, College of MVLS, University of Glasgow, Royal Infirmary, Glasgow, Scotland, UK

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SpringerPlus 2013, 2:378  doi:10.1186/2193-1801-2-378

Published: 10 August 2013



The aim of this study was to determine whether reclassifying the Fuhrman grading system provides further prognostic information.

Materials and methods

We studied the pathological features and cancer specific survival of 237 patients with clear cell cancer undergoing surgery between 1997–2007 in a single centre. The original Fuhrman grading system was investigated as well as various simplified models utilising the original Fuhrman grade.


The median follow up was 69 months. On univariate analysis, the conventional Fuhrman grading system as well various simplified models were predicative of cancer specific survival. On multivariate analysis, only the three tiered modified model in which grades 1 and 2 were combined whilst grades 3 and 4 were kept separate was an independent predictor of cancer specific survival (p=0.001, HR 2.17, 95% CI 1.37-3.43). Furthermore this simplified model demonstrated a stronger relationship to recurrence than the conventional 4 tiered Fuhrman grading system.


A modified, three-tiered Fuhrman grading system has been demonstrated to be an independent predictor of cancer specific survival.

Renal cell cancer; Fuhrman grade