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, 33 (10), 427.e17-23

Percentage of Sarcomatoid Component as a Prognostic Indicator for Survival in Renal Cell Carcinoma With Sarcomatoid Dedifferentiation

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Percentage of Sarcomatoid Component as a Prognostic Indicator for Survival in Renal Cell Carcinoma With Sarcomatoid Dedifferentiation

Mehrad Adibi et al. Urol Oncol.

Abstract

Objective: Renal cell carcinoma with sarcomatoid dedifferentiation (sRCC) is associated with higher stage of presentation and worse survival. The objective of this study was to examine the clinicopathologic characteristics associated with overall survival (OS), specifically examining the percentage of sarcomatoid component (PSC).

Methods: We reviewed clinicopathologic data for all nephrectomized patients with confirmed sRCC. Histologic slides were rereviewed by dedicated genitourinary pathologists to ascertain PSC. Patient characteristics were tabulated overall and by disease stage. Cutpoints in the PSC providing a meaningful difference in OS were identified by recursive partitioning analysis (RPA). Factors selected included age group, gender, race, clinical stage, tumor histology, presurgical systemic therapy, lymphovascular invasion, and tumor size. The Kaplan-Meier method and log-rank test were used to assess differences in OS.

Results: Among 186 patients with sRCC, 64 (34%) had localized, and 122 (66%) had metastatic disease at presentation. Patients had primarily clear cell histology (73%). Median follow-up was 12.1 months (range: 0.1-242.2mo). Median OS was 12.6 months (95% CI: 10.7-14.9mo). Univariate RPA identified a PSC cutpoint of 10% as prognostically significant. Patients with PSC>10% were at higher risk of death when compared with patients with PSC≤10% (45% vs. 61% 1-y OS; P = 0.04). Multivariate RPA revealed that tumor size, presence of metastatic disease, and PSC were significantly associated with OS. Among 4 identified groups, patients with localized disease and tumor size≤10cm were most likely to be alive at 1 year (89%), and patients with metastatic disease and PSC>40% were least likely to be alive at 1 year (28%; P<0.001).

Conclusion: PSC appears to be a prognostic factor in patients with sRCC, with larger percentage of involvement portending a worse survival, especially in patients with metastatic disease.

Keywords: Nephrectomy; Percentage; Recursive partitioning analysis; Renal cell carcinoma; Sarcomatoid.

Figures

Figure 1
Figure 1
Overall Survival
Figure 2
Figure 2
Figure 2A. Univariate Recursive Partitioning Analysis for Overall Survival. The PSC was split at 10% to distinguish patients with better and worse survival. Patients with higher sarcomatoid percentage were more likely to die. PSC= Percent sarcomatoid component Figure 2B. Overall Survival by Percent Sarcomatoid; PSC= Percent sarcomatoid component
Figure 2
Figure 2
Figure 2A. Univariate Recursive Partitioning Analysis for Overall Survival. The PSC was split at 10% to distinguish patients with better and worse survival. Patients with higher sarcomatoid percentage were more likely to die. PSC= Percent sarcomatoid component Figure 2B. Overall Survival by Percent Sarcomatoid; PSC= Percent sarcomatoid component
Figure 3
Figure 3
Figure 3A. Multivariate Recursive Partitioning Analysis for Overall Survival. The primary factor associated with survival was clinical stage (localized versus metastatic). Among patients with localized disease, tumor size was the strongest factor associated with survival. Among patients with metastatic disease, the percentage sarcomatoid was the strongest factor associated with survival. In this setting, having a sarcomatoid percentage more than 40% is associated with the worst survival. PSC= Percent sarcomatoid component Figure 3B. Overall Survival by Multivariate Recursive Partitioning Analysis Groups; PSC= Percent sarcomatoid component
Figure 3
Figure 3
Figure 3A. Multivariate Recursive Partitioning Analysis for Overall Survival. The primary factor associated with survival was clinical stage (localized versus metastatic). Among patients with localized disease, tumor size was the strongest factor associated with survival. Among patients with metastatic disease, the percentage sarcomatoid was the strongest factor associated with survival. In this setting, having a sarcomatoid percentage more than 40% is associated with the worst survival. PSC= Percent sarcomatoid component Figure 3B. Overall Survival by Multivariate Recursive Partitioning Analysis Groups; PSC= Percent sarcomatoid component

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