Sella A, Logothetis C J, Ro J Y, Swanson D A, Samuels M L
Cancer. 1987 Sep 15;60(6):1313-8. doi: 10.1002/1097-0142(19870915)60:6<1313::aid-cncr2820600625>3.0.co;2-1.
Of 920 patients with histologically confirmed renal cell carcinoma (RCC) seen at University of Texas M. D. Anderson Hospital over a 10-year period, 44 (4.8%) had the sarcomatoid variant. The authors show that, although sarcomatoid RCC has as common denominators with classic RCC in certain epidemiologic parameters such as age and sex, its biologic behavior is different. It is more malignant, has a higher metastatic rate, ultimate recurrence in localized disease which translates to a shorter survival time. Metastasis at presentation, advanced age (older than 59 years) and female sex were a associate with a worse prognosis. This entity is characterized by a high incidence of bone metastasis at presentation (48%) and by a tendency toward pathologic bone fractures. All of the untreated patients died very soon after diagnosis (median, 3.8 months), whereas all of the patients treated with the various systemic modalities initiated only in the presence of metastatic disease survived significantly longer (median, 13.0 months). Of the eight patients who were treated with doxorubicin HCI chemotherapy regimens two (on CYVADIC) showed complete responses and are the only survivors (50, 65 months). Four patients treated with interferon had the longest median survival (41.0 months). These results suggest that CYVADIC chemotherapy should be combined with interferon in this entity. Since surgery is not curative in early stages of sarcomatoid RCC, adjuvant therapy with those agents should be considered.
在德克萨斯大学MD安德森癌症中心10年间收治的920例经组织学确诊的肾细胞癌（RCC）患者中，44例（4.8%）为肉瘤样变型。作者指出，尽管肉瘤样肾细胞癌在年龄和性别等某些流行病学参数方面与经典肾细胞癌有共同特征，但其生物学行为有所不同。它更具恶性，转移率更高，局部疾病最终会复发，这意味着生存时间更短。初诊时即发生转移、高龄（59岁以上）和女性与预后较差相关。该实体的特点是初诊时骨转移发生率高（48%）且有发生病理性骨折的倾向。所有未接受治疗的患者在诊断后很快死亡（中位生存期3.8个月），而所有仅在出现转移疾病时才开始采用各种全身治疗方式的患者存活时间明显更长（中位生存期13.0个月）。在接受盐酸阿霉素化疗方案治疗的8例患者中，2例（采用CYVADIC方案）显示完全缓解，是仅有的幸存者（分别为50个月和65个月）。4例接受干扰素治疗的患者中位生存期最长（41.0个月）。这些结果表明，在该实体中CYVADIC化疗应与干扰素联合使用。由于手术在肉瘤样肾细胞癌早期无法治愈，应考虑使用这些药物进行辅助治疗。
