Outcomes of Patients with Renal Cell Carcinoma and Sarcomatoid Dedifferentiation Treated with Nephrectomy and Systemic Therapies: Comparison between the Cytokine and Targeted Therapy Eras

Abstract

Purpose To study the overall survival and prognostic factors of patients with sarcomatoid renal cell carcinoma treated with nephrectomy and systemic therapy in the cytokine and targeted therapy eras. Materials and Methods This is a retrospective study of patients with sarcomatoid renal cell carcinoma who had nephrectomy and received systemic therapy at our center in the cytokine era (1987–2005) or the targeted therapy era (2006–2015). Multivariate regression models were used to determine the association of covariables with survival. Results Among 199 patients with sarcomatoid renal cell carcinoma, 167 (83.9%) have died (median overall survival 16.5 months; 95% CI: 15.2, 20.9). Survival of patients with clear-cell histology was significantly longer vs. those with non-clear cell histology (p = 0.034). Patients with synchronous metastatic disease had a significantly shorter survival compared with patients with metachronous metastatic disease (median 12.1 months vs. 23.3 months; p = 0.0064). Biopsy of the primary tumor or a metastatic site could detect the presence of sarcomatoid features in only 7.5% of cases. Although a significant improvement in survival rate was observed in the first year for patients treated in the targeted therapy era (p = 0.011), this effect was attenuated at year 2, disappeared at years 3–5 after diagnosis, and was not evident in patients with poor risk features. Conclusions Patients with sarcomatoid renal cell carcinoma still have poor prognosis with no clear long-term benefit of targeted therapy, underscoring the need to develop more effective systemic therapies for these patients.

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

“…Compared to the cytokine therapy era, the targeted therapy era has achieved significant improvement in survival in RCC. However, RCC with sarcomatoid differentiation has been shown to have a poor response to targeted therapy [4,29], and this may influence prognosis and survival.…”

Analysis of the factors influencing the survival time of patients with sarcomatoid renal cell carcinoma

“…Surgery alone is often an inadequate measure to cure patients (10)(11)(12). Furthermore, SRCC does not respond well to cytotoxic chemotherapy, cytokines and targeted therapies (9,13). A higher percentage of sarcomatoid features are also associated with a poorer survival (14,15).…”

Rapid recurrence and radiographic progression of sarcomatoid renal cell carcinoma

“…reported 167 succumbed with median OS being 16.5 months (94% at six months, 67% at 12 months, 38% at two years, 14% at five years). 3 Chemotherapy did not improve OS in their cohort however, there was a trend towards improved survival in the era of targeted therapy. Recently, a phase III randomized, double-blind, placebo controlled trial with adjuvant sunitinib was reported by Ravaud and colleagues.…”

“…The overall survival (OS) for patients with sRCC can be as little as 4 months. 3 We present a case of sRCC that recurred rapidly in the nephrectomy bed despite negative margins in the pathology specimen.…”