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. 2020 Oct 8:10:591001.
doi: 10.3389/fonc.2020.591001. eCollection 2020.

Prognostic Significance of Sarcomatoid Differentiation in Patients With Metastatic Renal Cell Carcinoma: A Systematic Review and Meta-Analysis

Hong Zhi  1 , Meiling Feng  2 , Suo Liu  1 , Ta Na  1 , Nandong Zhang  1 , WuEn BiLiGe  1
Affiliations

Prognostic Significance of Sarcomatoid Differentiation in Patients With Metastatic Renal Cell Carcinoma: A Systematic Review and Meta-Analysis

Hong Zhi et al. Front Oncol. .

Abstract

Background: To date, the prognostic value of sarcomatoid differentiation in patients having metastatic renal cell carcinoma (mRCC) remains inconclusive. A systematic review and meta-analysis were conducted.

Materials and methods: Relevant literatures were obtained from PubMed, Embase, and Cochrane Library published prior to May, 2020. All patients were diagnosed with mRCC and treated with surgery, cytokine therapy, targeted therapy, and immunotherapy. Sarcomatoid differentiation in the pathological specimens was identified. Each endpoint [overall survival (OS), progression-free survival (PFS), and cancer-specific survival (CSS)] was assessed using a multivariable adjusted hazard ratio (HR) and 95% confidence interval (CI).

Results: Fifteen observational studies having 5,828 patients with mRCC were included. The merged results showed that patients presenting sarcomatoid differentiation had a significantly inferior OS (HR: 2.26, 95% CI: 1.82-2.81; P < 0.001), PFS (HR: 2.28, 95% CI: 1.63-3.19; P < 0.001), and CSS (HR: 2.27, 95% CI: 1.51-3.40; P < 0.001) compared to those without sarcomatoid differentiation. Subgroup analysis based on publication year, patient population, country, number of cases, and NOS score did not change the direction of results. A significant publication bias was identified for OS, but no publication bias was identified for PFS. Moreover, sensitivity analysis also verified the robustness of the results.

Conclusion: This study suggested that sarcomatoid differentiation was correlated to unfavorable clinical outcomes in mRCC and may be a poor prognostic factor incorporating to prognostic models for mRCC patients.

Keywords: meta-analysis; metastatic renal cell carcinoma; prognosis; sarcomatoid differentiation; systematic review.

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Figures

Figure 1
Figure 1
Flow chart of literature search and selection process.
Figure 2
Figure 2
Forest plots of pooled hazard ratios for overall survival.
Figure 3
Figure 3
Forest plots of pooled hazard ratios for progression-free survival and cancer-specific survival.
Figure 4
Figure 4
Funnel plots of overall survival and progression-free survival. (A) overall survival; (B) progression-free survival.
Figure 5
Figure 5
Sensitivity analyses of overall survival and progression-free survival. (A) overall survival; (B) progression-free survival.
See this image and copyright information in PMC

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