Sarcomatoid Renal Cell Carcinoma: Population-Based Study of 879 Patients

Alevizakos, Michail; Gaitanidis, Apostolos; Nasioudis, Dimitrios; Msaouel, Pavlos; Appleman, Leonard J.

doi:10.1016/j.clgc.2019.01.005

Cited by 46 publications

(67 citation statements)

References 29 publications

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“…Adverse histologic features, including necrosis, lymphovascular invasion, high nuclear grade, rhabdoid as well as sarcomatoid histology have a remarkable prognostic value, even in patients with small renal masses [6]. Sarcomatoid histology, which is characterized by the loss of typical epithelial features ("dedifferentiation"), is reported in approximately 5-10% of cases, most frequently in clear-cell RCC [7].…”

Section: Introductionmentioning

confidence: 99%

“…Sarcomatoid histology, which is characterized by the loss of typical epithelial features ("dedifferentiation"), is reported in approximately 5-10% of cases, most frequently in clear-cell RCC [7]. In metastatic RCC patients, sarcomatoid histology was associated with a poor median disease-specific survival of 9 months [6], with chemotherapy and targeted therapy showing disappointing efficacy in these patients [8]. Anti PD-1/PDL-1 agents may be more effective in patients with sarcomatoid histology, possibly because of a higher PD-L1 expression [9] and a higher mutational burden [10].…”

Section: Introductionmentioning

confidence: 99%

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Outcomes Associated with First-Line anti-PD-1/ PD-L1 agents vs. Sunitinib in Patients with Sarcomatoid Renal Cell Carcinoma: A Systematic Review and Meta-Analysis

Buonerba

Dolce²,

Iaccarino

et al. 2020

Cancers

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: Immunotherapy based on anti PD-1/PD-L1 inhibitors has proven to be more effective than sunitinib in the first-line setting of advanced renal cell carcinoma (RCC). RCC patients with sarcomatoid histology (sRCC) have a poor prognosis and limited therapeutic options. We performed a systematic review and a meta-analysis of randomized-controlled trials (RCTs) of first-line anti PD-1/PDL-1 agents vs. sunitinib, presenting efficacy data in the sub-group of sRCC patients. The systematic research was conducted on Google Scholar, Cochrane Library, PubMed and Embase and updated until 31th January, 2020. Abstracts from ESMO and ASCO (2010–2019) were also reviewed. Full texts and abstracts reporting about RCTs testing first-line anti-PD-1/ PD-L1 agents vs. sunitinib in RCC were included if sRCC sub-group analyses of either PFS (progression-free survival), OS (overall survival) or radiological response rate were available. Pooled data from 3814 RCC patients in the ITT (intention-to-treat) population and from 512 sRCC patients were included in the quantitative synthesis. In the sRCC sub-group vs. the ITT population, pooled estimates of the PFS-HRs were 0.57 (95%: 0.45–0.74) vs. 0.79 (95% CI: 0.70–0.89), respectively, with a statistically meaningful interaction favoring the sRCC sub-group (pooled ratio of the PFS-HRs = 0.64; 95% CI: 0.50–0.82; p < 0.001). Pooled estimates of the difference in CR-R (complete response-rate) achieved with anti-PD-1/PDL-1 agents vs. sunitinib were + 0.10 (95% CI: 0.04–0.16) vs. + 0.04 (95% CI: 0.00–0.07) in the sRCC vs. the non-sRCC sub groups, with a statistically meaningful difference of + 0.06 (95% CI: 0.02–0.10; p = 0.007) favoring the sRCC sub-group. Sarcomatoid histology may be associated with improved efficacy of anti PD-1/PDL-1 agents vs. sunitinib in terms of PFS and CR-R.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Outcomes Associated with First-Line anti-PD-1/ PD-L1 agents vs. Sunitinib in Patients with Sarcomatoid Renal Cell Carcinoma: A Systematic Review and Meta-Analysis

Buonerba

Dolce²,

Iaccarino

et al. 2020

Cancers

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“…Shuch et al (17) found that the median tumor size was 9.5 cm, ranging from 2.5 to 30 cm. A study of 879 patients with RCCs based on the SEER database showed the median tumor size was 8.3 cm, interquartile ranging from 5.5 to 12 cm (20). In our cohort, the median tumor size was 7.0 cm, ranging from 1.6 to 15 cm.…”

Section: Discussionmentioning

confidence: 99%

“…Pamela et al (8) described 23 patients with RCCs; the median progression‐free survival (PFS) was 7 months, and the median disease‐specific survival was 18 months. In the report of Alevizakos et al (20), the median disease‐specific survival (DSS) was 9 months. Of the 139 patients in our cohort, 74 died, with a mortality rate of 53.2%.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, Brookman‐May et al (25) demonstrated that metastases, pathologic T stage, positive lymph nodes and tumor size were independent predictors of cancer‐specific survival (CSS) in patients with RCCs. In the report of Alevizakos et al (20), older age and higher tumor stage (stage III and stage IV) were considered to independently affect DSS. However, Cangiano et al (19) confirmed that pathologic T stage did not significantly correlate with outcome, but lymph node‐positive individuals had a higher mortality rate.…”

Section: Discussionmentioning

confidence: 99%

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Clinicopathologic features and prognostic factors in patients with renal cell carcinoma with sarcomatoid differentiation

Zhao

Chen

Xie

et al. 2020

APMIS

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Clinicopathologic features and prognostic factors in patients with renal cell carcinoma with sarcomatoid differentiation. APMIS 2020; 128: 378-386.Renal cell carcinoma with sarcomatoid differentiation (RCCs) is rare, accounting for 1-8% of all RCC histological subtypes. In this study, we examined 139 patients with RCCs and aimed to explore their clinicopathologic features and prognostic factors. From January 2007 to January 2019, patients who were pathologically diagnosed with RCCs were included in this retrospective study. Data on clinicopathologic features and overall survival were collected. The expression of CK, vimentin, CK7, and CD10 in the sarcomatoid regions of RCCs was detected. The Kaplan-Meier curves and log-rank tests were used to describe the effect of clinicopathologic characteristics on overall survival. A Cox regression model was used to evaluate risk factors for prognosis. A total of 139 patients with RCCs were identified. The median age at diagnosis was 60 years. The median survival time of all patients was 39 months. The three-and five-year survival rates were 50.2% and 44.0%, respectively. A high pathologic T stage (pT3 and pT4), microvascular invasion, and lymph node metastasis were significant predictors of prognosis. Pathologic T4 stage and lymph node metastasis were independent prognostic factors for overall survival in patients with RCCs. Furthermore, the expression of CD10 was a prognostic factor for overall survival. In this study, a relatively large cohort of patients with RCCs was analyzed. We summarized the clinicopathologic features of RCCs and explored the risk factors for prognosis. Our findings may provide valuable prediction for clinical strategy.

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Comparison of tyrosine kinase inhibitors in the treatment of metastatic renal cell carcinoma with rhabdoid and sarcomatoid differentiations

et al. 2023

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Objective To investigate the efficacy of tyrosine kinase inhibitors (TKIs) in the treatment of metastatic renal cell carcinoma (mRCC) with rhabdoid (mRCC‐R) and sarcomatoid (mRCC‐S) differentiations. Materials and Methods In this single‐institutional cohort study, we included patients with RCC with rhabdoid (RCC‐R) and sarcomatoid (RCC‐S) differentiation, who were treated with TKIs after metastasis at our institute from 2013 to 2021. Patient characteristics, treatments, and clinical outcomes were recorded and analyzed. Results We identified 111 patients with RCC‐R or RCC‐S differentiations, of which 23 patients were included in the final analysis. Of the 23 patients, 10 (43.5%) were grouped as mRCC‐R and 13 (56.5%) as mRCC‐S. At a median follow‐up of 40 months, mRCC‐R and mRCC‐S progressed in 7 of 10 and 12 of 13 patients, respectively. In addition, four and eight patients died in the mRCC‐R and mRCC‐S groups, respectively. The median progression‐free survival (PFS) of the two groups was 19 months (mRCC‐R: 95% confidence interval [CI] 4.08–33.92) and 7 months (mRCC‐S: 95% CI 2.03–11.96), while the median overall survival (OS) was 32 months and 21 months, respectively. mRCC‐S had a worse prognosis than mRCC‐R. Based on the univariate Cox regression model, single metastasis or multiple metastasis of tumor, rhabdoid differentiation, and sarcomatoid differentiation were predictors of PFS but not OS. Conclusion The efficacy of TKIs in the treatment of mRCC‐R and mRCC‐S may be different.

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Sarcomatoid Renal Cell Carcinoma: Population-Based Study of 879 Patients

Cited by 46 publications

References 29 publications

Outcomes Associated with First-Line anti-PD-1/ PD-L1 agents vs. Sunitinib in Patients with Sarcomatoid Renal Cell Carcinoma: A Systematic Review and Meta-Analysis

Outcomes Associated with First-Line anti-PD-1/ PD-L1 agents vs. Sunitinib in Patients with Sarcomatoid Renal Cell Carcinoma: A Systematic Review and Meta-Analysis

Clinicopathologic features and prognostic factors in patients with renal cell carcinoma with sarcomatoid differentiation

Comparison of tyrosine kinase inhibitors in the treatment of metastatic renal cell carcinoma with rhabdoid and sarcomatoid differentiations

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