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Comparative Study
. 2017 Sep;198(3):530-537.
doi: 10.1016/j.juro.2017.04.067. Epub 2017 Apr 11.

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

Sarp K Keskin  1 , Pavlos Msaouel  2 , Kenneth R Hess  3 , Kai-Jie Yu  4 , Surena F Matin  1 , Kanishka Sircar  5 , Pheroze Tamboli  5 , Eric Jonasch  2 , Christopher G Wood  1 , Jose A Karam  1 , Nizar M Tannir  6
Affiliations
Comparative Study

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

Sarp K Keskin et al. J Urol. 2017 Sep.

Abstract

Purpose: We studied overall survival and prognostic factors in 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 underwent nephrectomy and received systemic therapy at our center in the cytokine era (1987 to 2005) or the targeted therapy era (2006 to 2015). Multivariate regression models were used to determine the association of covariables with survival.

Results: Of the 199 patients with sarcomatoid renal cell carcinoma 167 (83.9%) 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 nonclear cell histology (p = 0.034). Patients with synchronous metastatic disease had significantly shorter survival than patients with metachronous metastatic disease (median 12.1 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 in patients treated in the targeted therapy era (p = 0.011), this effect was attenuated at year 2, disappeared at years 3 to 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. This underscores the need to develop more effective systemic therapies for these patients.

Keywords: carcinoma; cytokines; kidney neoplasms; molecular targeted therapy; neoplasm metastasis; renal cell.

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Figures

Figure 1
Figure 1
Probability of survival from time of diagnosis in patients with sRCC
Figure 2
Figure 2
Overall survival (OS) after nephrectomy in patients with sRCC stratified by A. stage at presentation and B. underlying histology
Figure 2
Figure 2
Overall survival (OS) after nephrectomy in patients with sRCC stratified by A. stage at presentation and B. underlying histology
Figure 3
Figure 3
Association between year of diagnosis and median overall survival (OS) from time of diagnosis.
Figure 4
Figure 4
Association between year of diagnosis and overall survival (OS) at 1 year, 3 years and 5 years
Figure 5
Figure 5
Overall survival (OS) in patients with sRCC stratified by A. the Memorial Sloan Kettering Cancer Center (MSKCC) and B. the international metastatic renal cell carcinoma database consortium (IMDC) criteria
Figure 5
Figure 5
Overall survival (OS) in patients with sRCC stratified by A. the Memorial Sloan Kettering Cancer Center (MSKCC) and B. the international metastatic renal cell carcinoma database consortium (IMDC) criteria
See this image and copyright information in PMC

Comment in

  • Editorial Comment.
    Shapiro DD, Abel EJ. Shapiro DD, et al. J Urol. 2017 Sep;198(3):537. doi: 10.1016/j.juro.2017.04.116. Epub 2017 Jun 20. J Urol. 2017. PMID: 28641080 No abstract available.
  • Editorial Comment.
    Bracarda S, Duranti S, Roviello G. Bracarda S, et al. J Urol. 2017 Sep;198(3):536-537. doi: 10.1016/j.juro.2017.04.115. Epub 2017 Jun 20. J Urol. 2017. PMID: 28641081 No abstract available.
  • Sarkomatoides Nierenzellkarzinom: schlechte Prognose trotz moderner Therapien.
    [No authors listed] [No authors listed] Aktuelle Urol. 2018 Apr;49(2):114-116. doi: 10.1055/s-0044-100017. Epub 2018 Mar 27. Aktuelle Urol. 2018. PMID: 29587312 German. No abstract available.

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