Original and reviewed nuclear grading according to the Fuhrman system : a multivariate analysis of 388 patients with conventional renal cell carcinoma

BACKGROUND. The objective of the current study was to evaluate the reproducibility of the Fuhrman nuclear grading system as well as its independent predictive value in a series of patients with conventional renal cell carcinoma (RCC). METHODS. The authors selected 388 patients who had undergone surgical treatment for conventional RCC between 1986 and 2000. Pathology slides from the selected patients were reviewed by a single pathologist, who reassigned a Fuhrman nuclear grade and assessed the presence of tumor necrosis. The pathologist was blinded to both the original pathologic diagnosis and follow-up data. The κ statistic was used to evaluate concordance between original and reviewed nuclear grades. The log-rank test was used for univariate analyses, and a Cox proportional hazards model was used for multivariate analyses. RESULTS. The original Fuhrman nuclear grade was Grade 1 (G1) in 111 patients (28.6%), G2 in 141 patients (36.3%), G3 in 108 patients (27.8%), and G4 in 28 patients (7.3%). After pathology slide review, nuclear grades were reassigned as follows: G1 in 49 patients (12.6%), G2 in 138 patients (35.6%), G3 in 150 patients (38.7%), and G4 in 51 patients (13.1%). The grade of concordance was moderate (κ = 0.44; P < 0.001). Univariate analyses identified three separate prognostic categories defined by nuclear grade (G1 and G2 vs. G3 vs. G4). Both the original and the reviewed Fuhrman nuclear grading systems were capable of independently predicting disease-specific survival in patients with conventional RCC. CONCLUSIONS. The interobserver reproducibility of Fuhrman nuclear grading was moderate. The substantial overlap in survival curves for G1 and G2 tumors provided an opportunity to cluster those categories, and the resulting three-tiered nuclear grading system was an independent predictor of cause-specific survival in patients with conventional RCC. Other independent predictors of survival included pathologic stage and tumor necrosis status

EDUCAZIONE ALLA SALUTE

Si descrivono l'approccio educativo e comunicativo profondo come strumento di promozione della salute, e le strategie di approccio educativo ai gruppi e alle popolazion

Igiene, Medicina Preventiva, Sanit\ue0 Pubblica. Seconda edizione.

La Seconda Edizione del Manuale di Igiene, Medicina Preventiva e Sanit\ue0 Pubblica, pur mantenendosi saldamente nel solco tracciato dalla lunga e gloriosa storia di testi e manuali elaborati dai grandi Maestri della disciplina igienistica che hanno guidato ed ispirato i nostri anni di studio e di lavoro, presenta aspetti vigorosamente innovativi. Questa Seconda Edizione del Manuale conferma l'ambizione di fornire allo studente un sicuro punto di riferimento sin dal suo primo anno di Universit\ue0, perch\ue9 lo rende consapevole che uno strumento bibliografico sar\ue0 a sua disposizione per tutta la durata dei suoi studi e gli consentir\ue0 di acquisire conoscenze in tutti i settori in cui oggi la moderna Igiene si articola. Nella Seconda Edizione si affiancano nuove proposte didattiche che tengano il passo coi tempi grazie all'affiatato lavoro del gruppo degli Autori. Ecco quindi fare la loro comparsa ambiti innovativi per la didattica nelle Facolt\ue0 mediche, quali HTA, HIA, Management e Leadership in Sanit\ue0, Salute Globale, Edilizia Ospedaliera, o argomenti antichi, ma sempre attuali, di cui \ue8 tuttavia necessaria una moderna e mirata rilettura, come l'Etica in Sanit\ue0