The Role of Cytoreductive Nephrectomy for Sarcomatoid Renal Cell Carcinoma: A 29-Year Institutional Experience

Abstract

Objective: To assess which patients respond best following cytoreductive nephrectomy for renal cell carcinoma (RCC) with sarcomatoid dedifferentiation (sRCC) and whether outcomes are improving over time. Methods:We identified 562 patients with metastatic RCC treated between 1989-2018 with cytoreductive nephrectomy. We reviewed baseline clinical and pathological characteristics, including the presence of sRCC, and metastatic sites at time of nephrectomy. The primary study endpoint was overall survival (OS). Univariate and multivariate Cox-regression analyses were used to identify significant predictors of OS. Results:The study cohort had 192 sRCC patients, with a median age of 59 years. Frequently involved metastatic locations were lung (n=115), retroperitoneal nodes (n=63) and axial skeleton (n=43). Lung metastasis were more prevalent in clear cell histology (p=0.0017) whereas nodal involvement was associated with non-clear cell subtypes (p=0.0064).Median follow-up was 14 months. Estimated 2-and 5-year OS were 34.1% and 14.8%, respectively. On multivariate analysis, metastases to the liver (HR=1.64; 95% CI 1.02-2.63; p=0.04), lung (HR=1.50; 95% CI 1.05-2.14; p=0.03), retroperitoneal nodes (HR=1.52; 95% CI 1.03-2.25; p=0.04) and non-clear cell histology (HR=1.61; 95% CI 1.10-2.35; p=0.01) were associated with worse OS in the sRCC cohort. Conclusion:OS after cytoreductive nephrectomy for sRCC and non-sRCC is improving over time. In patients with sRCC, presentations with unifocal metastasis not involving the liver or lung,

Evolving biological associations of upfront cytoreductive nephrectomy in metastatic renal cell carcinoma

“…A similar evaluation of IMDC risk factor dynamics in patients receiving systemic therapy may enable longitudinal monitoring of tumor responses, with the added benefit of classifying risk groups by also incorporating the nonmodifiable risk factor of less than 1 year from diagnosis to commencing systemic therapy. We demonstrated that patients with 2 or more risk factors (who would likely be poor‐risk patients) were less likely to reduce their number of IMDC factors if they had non–clear cell histology, sarcomatoid dedifferentiation, or systemic symptoms; this corroborated studies showing that these features confer poorer prognoses 21‐23 . Furthermore, among these patients with high‐risk disease, a postoperative reduction in risk factors was associated with improved OS.…”

Dissecting Outcomes: Should Cytoreductive Nephrectomy Be Performed for Patients With Metastatic Renal Cell Carcinoma With Sarcomatoid Dedifferentiation?

“…Although the role of cytoreductive nephrectomy in this particular disease subset has continued to be debated, new evidence from a large cohort at Memorial Sloan Kettering Cancer Center found that, among patients whose tumors have sarcomatoid differentiation, a subset of patients may benefit from cytoreductive nephrectomy if they have clear cell histology, unifocal metastasis not involving the lung or liver, and node-negative disease ( 27 ). It is important to note that this is for all patients with sRCC, not only for those with metastatic cases ( 28 – 30 ). It has been shown that atezolizumab + bevacizumab for patients with variant histology or more than 20% sarcomatoid dedifferentiation showed an improvement in progression-free survival (median progression-free survival, 8.3 months [95% CI.…”

Factores de riesgo para el desarrollo de complicaciones posquirúrgicas en pacientes con cáncer renal metastásico tratados con nefrectomía citorreductora

“…En nuestra serie, los grados nucleares 3 y 4 fueron los más frecuentes, lo que, de acuerdo con la literatura, se asocia con enfermedad metastásica hasta en un 79% de los casos 17 . El 23.4% de nuestros pacientes presentaron diferenciación sarcomatoide, hallazgo que también se ha asociado con un peor pronóstico 22 .…”