Clinically nonmetastatic renal cell carcinoma with sarcomatoid dedifferentiation: Natural history and outcomes after surgical resection with curative intent

Abstract

Purpose Renal cell carcinoma with sarcomatoid dedifferentiation (sRCC) is an aggressive malignancy associated with a poor prognosis. While existing literature focuses on patients presenting with metastatic disease, characteristics and outcomes for patients with localized disease are not well described. We aimed to evaluate post-nephrectomy characteristics, outcomes, and predictors of survival in patients with sRCC who presented with clinically localized disease. Patients and Methods An IRB-approved review from 1986–2011 identified 77 patients who presented with clinically localized disease, underwent nephrectomy and had sRCC in their primary kidney tumor. Clinical and pathologic variables were captured for each patient. Overall survival (OS) and recurrence-free survival (RFS) were calculated for all patients and those who had no evidence of disease (NED) following nephrectomy, respectively. Comparisons were made with categorical groupings in proportional hazards regression models for univariable and multivariable analyses. Results OS for the entire cohort (N=77) at 2 years was 50%. A total of 56 (77%) patients of the 73 who were NED following nephrectomy experienced a recurrence, with a median time to recurrence of 26.2 months. On multivariable analysis, tumor stage, pathologically positive lymph nodes, and year of nephrectomy were significant predictors of both OS and RFS. Limitations include the retrospective nature of this study and relatively small sample size. Conclusions Long-term survival for patients with sRCC, even in clinically localized disease is poor. Aggressive surveillance of those who are NED following nephrectomy is essential and further prospective studies evaluating the benefit of adjuvant systemic therapies in this cohort are warranted.

Risk factors for recurrence after surgery in non‐metastatic RCC with thrombus: a contemporary multicentre analysis

“…More recent studies with larger patient numbers identify thrombus present above the diaphragm as predictive of risk of perioperative complications but not of cancer outcomes . The presence of sarcomatoid features is predictive of poor cancer outcomes in non‐metastatic disease , but the lack of predictive significance in the present cohort may reflect the relatively few patients with sarcomatoid features.…”

Impact of sarcomatoid differentiation and rhabdoid differentiation on prognosis for renal cell carcinoma with vena caval tumour thrombus treated surgically

“…Zhang et al [20] suggested that PSD was an independent predictor of prognosis. However, the prognostic value of PSD in patients with RCC is still under debate [21,22]. Our study failed to include PSD in the multivariate analysis model due to insufficient data.…”

Percentage of sarcomatoid component as a prognostic indicator for survival in renal cell carcinoma with sarcomatoid dedifferentiation

“…Specifically, the presence of sarcomatoid elements is associated with higher stage at presentation, aggressive disease course, and decreased patient survival, both in the localized and metastatic settings. [6–9] Although there have been multiple reports of various chemotherapeutic regimens in the literature, the response rates have been modest at best. [10, 11] Recently, several studies have reported the use of systemic targeted therapy in sRCC patients, however, response rates varied between 0% to 15.8% with no statistically significant differences between targeted agents and chemotherapy, indicating a need for better risk stratification.…”