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

Abstract

Background: Sarcomatoid differentiation in renal cell carcinoma (RCC) with vena caval tumour thrombus has been shown to be associated with aggressive behaviours and poor prognosis; however, evidence of the impact of rhabdoid differentiation on prognosis is lacking. This study evaluated the impact of sarcomatoid differentiation and rhabdoid differentiation on oncological outcomes for RCC with vena caval tumour thrombus treated surgically. Methods: We retrospectively analysed patients treated surgically for RCC with vena caval tumour thrombus at our institute from Jan 2015 to Nov 2018. Prognostic variables were evaluated for associations with progression-free survival (PFS) and cancer-specific survival (CSS) by Kaplan-Meier survival analysis and log-rank test. Univariate and multivariate analyses were performed to determine independent prognostic variables. Results:We identified 125 patients with RCC and vena caval tumour thrombus, including 17 (13.6%) with sarcomatoid differentiation alone, 8 (6.4%) with rhabdoid differentiation alone and 3 (2.4%) with both sarcomatoid and rhabdoid differentiation. Compared to pure RCC, patients with sarcomatoid differentiation but not rhabdoid differentiation have worse PFS (p = 0.018 and p = 0.095, respectively). The univariate and multivariate analyses both showed sarcomatoid differentiation as a significant predictor of PFS. Compared to pure RCC, patients with sarcomatoid differentiation (p = 0.002) and rhabdoid differentiation (p = 0.001) both had significantly worse CSS. The univariate analysis showed sarcomatoid differentiation, rhabdoid differentiation, metastasis and blood transfusion as significant predictors of CSS (All, p < 0.05). In the multivariate analysis, sarcomatoid differentiation (HR 3.90, p = 0.008), rhabdoid differentiation (HR 3.01, p = 0.042), metastasis (HR 3.87, p = 0.004) and blood transfusion (HR 1.34, p = 0.041) all remained independent predictors of CSS.Conclusions: Sarcomatoid differentiation and rhabdoid differentiation are both independent predictors of poor prognosis in RCC with vena caval tumour thrombus treated surgically.

Nomogram for predicting survival of renal cell carcinoma with tumor thrombus based on perioperative clinicopathological factors from a Chinese high‐volume center

“…Consistent with previous studies in our center, we found that the sarcomatoid feature is the independent predictor of poor prognosis in RCC and VTT treated surgically 19,20 . Abel et al 21 .…”

Simultaneous ipsilateral rhabdoid renal cell carcinoma and multifocal urothelial carcinoma of the ureter in a patient from the region of Balkan endemic nephropathy: Case report and literature review

“…Rhabdoid differentiation in clear cell RCC has a typical pattern of dedifferentiation, suggesting poor prognosis, as reported by Yang et al [19]. Investigating the impact of rhabdoid and sarcomatoid differentiation on prognosis in 264 patients operated due to RCC, Kara et al reported that unlike sarcomatoid, rhabdoid differentiation was not associated with increased risk of lethality [20].…”

Influence of Deep Invasive Tumor Thrombus on the Surgical Complexity and Prognosis of Patients With Non-Metastatic Renal Cell Carcinoma Combined With Venous Tumor Thrombus

“…In previous studies, blood indicators such as hemoglobin and neutrophils have been reported to be related to the prognosis ( 15 , 16 ). Sarcomatoid differentiation is currently considered a rare histologic variant that predicts aggressive behavior and poor prognosis ( 17 ). RCC with sarcomatoid differentiation is classified as grade 4 by the WHO/ISUP grading system ( 18 ).…”