M. Marchioni, R. Campi, A. Minervini, T. Klatte, M. C. Kriegmair, S. Erdem, U. Capitanio, E. Roussel, M. Albertsen, Matthias Heck, F. Porpiglia, S. Van Bruwaene, E. Linares, V. Hevia, M. Musquera, I. Darweesh, R. Autorino, N. Pavan, A. Antonelli, J. Rubio-Briones, A. Veccia, E. Checcucci, F. Claps, C. Mir
- Introduction: Sarcomatoid features (SF) correlate with worst survival
outcomes in patients with primary metastatic renal cell carcinoma
(mRCC). Some reports suggested a cut-off above 25% sarcomatoid
features as a predictor of poorer outcome. We aimed to report survival
outcomes on a large dataset of patients with SF treated with
cytoreductive nephrectomy (CN).
Materials and methods: A purpose built multi-institutional inter-
national database (REgistry of MetAstatic RCC- REMARCC project) was
used for this retrospective analysis. Patients with diagnosis of mRCC
treated with CN with or without metastasectomy were included. The
cohort was stratified according to the presence of SF in the primary
specimen. Kaplan Meier methods and Cox proportional Hazards
Regression Analyses were used to estimate overall mortality rates. The
reverse Kaplan Meier method was used to estimate the median (IQR)
follow-up.
Results: Overall 617 patients who underwent CN were included. OfIntroduction: Sarcomatoid features (SF) correlate with worst survival
outcomes in patients with primary metastatic renal cell carcinoma
(mRCC). Some reports suggested a cut-off above 25% sarcomatoid
features as a predictor of poorer outcome. We aimed to report survival
outcomes on a large dataset of patients with SF treated with
cytoreductive nephrectomy (CN).
Materials and methods: A purpose built multi-institutional inter-
national database (REgistry of MetAstatic RCC- REMARCC project) was
used for this retrospective analysis. Patients with diagnosis of mRCC
treated with CN with or without metastasectomy were included. The
cohort was stratified according to the presence of SF in the primary
specimen. Kaplan Meier methods and Cox proportional Hazards
Regression Analyses were used to estimate overall mortality rates. The
reverse Kaplan Meier method was used to estimate the median (IQR)
follow-up.
Results: Overall 617 patients who underwent CN were included. Of all,
78 (12.6%) patients received synchronous/metachronous metastasect-
omy. A total of 118 (19.1%) patients had SF in the final specimen. The
median involvement of the sarcomatoid component was 35.0% (IQR
10.0–72.5%). Patients with SF were more frequently classified as poor
prognosis according to Heng’s criteria (44.9 vs. 33.3%, p = 0.022).
Moreover, patients with sarcomatoid features harbored more
frequently locally advanced disease [pT3-4 stage tumors (88.1 vs.
73.7%, p = 0.003) and pN1 tumors (28.8 vs. 18.22%, p = 0.025)]. The
median follow-up was 55.1 (IQR 25.9–120.6) months. Overall, 395
(64.0%) deaths were recorded in the whole cohort. The median overall
survival was shorter for patients with SF (13.1 vs. 27.9 months,
p < 0.001). However, neither patients with a SF >35% nor those with a
SF >50% showed higher overall mortality rates than those with <35%
and <50% SF, respectively ( p = 0.720 and 0.960, respectively). Patients with SF showed higher overall mortality rates even after accounting for Heng’s risk group, type of surgery and pT and pN stage (HR: 1.35, 95% CI: 1.04–1.75, p = 0.024).
Conclusions: Patients with mRCC and SF experience higher mortality
rates, even when accounting for pathologic status and risk group.
Interestingly, the extent of sarcomatoid defined as >50% in the
specimen was not predictive of higher mortality rates within patients
with SF. These results suggest that all patients with a SF on primary
tumor should be carefully followed independently of percentage of
sarcomatoid dedifferentiation.…
