Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Feb:136:169-175.
doi: 10.1016/j.urology.2019.08.058. Epub 2019 Nov 11.

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

Andrew W Silagy  1 , Roy Mano  2 , Kyle A Blum  2 , Renzo G DiNatale  2 , Julian Marcon  2 , Satish K Tickoo  3 , Eduard Reznik  4 , Jonathan A Coleman  2 , Paul Russo  2 , A Ari Hakimi  5
Affiliations

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

Andrew W Silagy et al. Urology. 2020 Feb.

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 and 2018 with cytoreductive nephrectomy. We reviewed baseline clinical and pathologic 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 = .0017) whereas nodal involvement was associated with nonclear cell subtypes (P = .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 = .04), lung (HR = 1.50; 95% CI 1.05-2.14; P = .03), retroperitoneal nodes (HR = 1.52; 95% CI 1.03-2.25; P = 0.04) and nonclear cell histology (HR = 1.61; 95% CI 1.10-2.35; P = .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, clear cell histology and node negative disease have better outcomes following cytoreductive nephrectomy and may yield greater benefit from the procedure.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Distribution of sRCC metastatic sites
Figure 2.
Figure 2.
Survival plots of: A) OS of sRCC by histology and lung metastases B) OS of sRCC by metastatic focality C) OS of non-sRCC vs sRCC D) OS of non-sRCC vs sRCC stratified by era
See this image and copyright information in PMC

Comment in

  • EDITORIAL COMMENT.
    Shapiro DD, Karam JA, Wood CG. Shapiro DD, et al. Urology. 2020 Feb;136:175. doi: 10.1016/j.urology.2019.08.059. Urology. 2020. PMID: 32033671 No abstract available.

References

    1. Gu L, Li H, Wang H, et al. Presence of sarcomatoid differentiation as a prognostic indicator for survival in surgically treated metastatic renal cell carcinoma. Journal of Cancer Research and Clinical Oncology. 2017;143:499–508. - PMC - PubMed
    1. Shuch B, Said J, La Rochelle JC, et al. Cytoreductive nephrectomy for kidney cancer with sarcomatoid histology--is up-front resection indicated and, if not, is it avoidable? J Urol. 2009;182:2164–2171. - PMC - PubMed
    1. Lebacle C, Pooli A, Bessede T, Irani J, Pantuck AJ, Drakaki A. Epidemiology, biology and treatment of sarcomatoid RCC: current state of the art. World Journal of Urology. 2018. - PubMed
    1. Cheville JC, Lohse CM, Zincke H, et al. Sarcomatoid renal cell carcinoma: an examination of underlying histologic subtype and an analysis of associations with patient outcome . The American journal of surgical pathology. 2004;28:435–441. - PubMed
    1. Shuch B, Bratslavsky G, Shih J, et al. Impact of pathological tumour characteristics in patients with sarcomatoid renal cell carcinoma. BJU international. 2012;109:1600–1606. - PMC - PubMed