Kim Timothy, Zargar-Shoshtari Kamran, Dhillon Jasreman, Lin Hui-Yi, Yue Binglin, Fishman Mayer, Sverrisson Einar F, Spiess Philippe E, Gupta Shilpa, Poch Michael A, Sexton Wade J
Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL.
Department of Genitourinary Pathology, Moffitt Cancer Center, Tampa, FL.
Clin Genitourin Cancer. 2015 Jun;13(3):225-30. doi: 10.1016/j.clgc.2014.12.001. Epub 2014 Dec 9.
The objective of this study was to determine if the percentage of sarcomatoid differentiation (%Sarc) in renal cell carcinoma (RCC) can be used for prognostic risk stratification, because sarcomatoid RCC (sRCC) is an aggressive variant of kidney cancer.
We performed a retrospective analysis of patients who underwent surgery for RCC at our institution between 1999 and 2012. Pathology slides for all sRCC cases were reexamined by a single pathologist and %Sarc was calculated. %Sarc was analyzed as a continuous variable and as a categorical variable at cut points of 5%, 10%, and 25%. Potential prognostic factors associated with overall survival (OS) were determined using the Cox regression model. OS curves were generated using Kaplan-Meier methods and survival differences compared using the log-rank test.
One thousand three hundred seven consecutive cases of RCC were identified, of which 59 patients had sRCC (4.5%). As a continuous variable %Sarc was inversely associated with OS (P = .023). Predictors of survival on multivariable analysis included pathologic (p) T status, tumor size, clinical (c) M status and %Sarc at the 25% level. OS was most dependent on the presence of metastatic disease (4 months vs. 21.2 months; P = .001). In cM0 patients with locally advanced (≥ pT3) tumors, OS was significantly diminished in patients with > 25 %Sarc (P = .045). However, %Sarc did not influence OS in patients with cM1 disease.
Patients with sRCC have a poor overall outcome as evidenced by high rates of recurrence and death, indicating the need for more effective systemic therapies. In nonmetastatic patients, the incorporation of %Sarc in predictive nomograms might further improve risk stratification.
本研究的目的是确定肾细胞癌（RCC）中肉瘤样分化百分比（%Sarc）是否可用于预后风险分层，因为肉瘤样肾细胞癌（sRCC）是一种侵袭性肾癌变体。
我们对1999年至2012年间在我院接受RCC手术的患者进行了回顾性分析。由一名病理学家重新检查所有sRCC病例的病理切片并计算%Sarc。%Sarc作为连续变量以及在5%、10%和25%的切点处作为分类变量进行分析。使用Cox回归模型确定与总生存期（OS）相关的潜在预后因素。使用Kaplan-Meier方法生成OS曲线，并使用对数秩检验比较生存差异。
共识别出1307例连续的RCC病例，其中59例患者患有sRCC（4.5%）。作为连续变量，%Sarc与OS呈负相关（P = .023）。多变量分析的生存预测因素包括病理（p）T分期、肿瘤大小、临床（c）M分期以及25%水平的%Sarc。OS最依赖于转移性疾病的存在（4个月对21.2个月；P = .001）。在局部晚期（≥ pT3）肿瘤的cM0患者中，%Sarc > 25%的患者OS显著缩短（P = .045）。然而，%Sarc对cM1疾病患者的OS没有影响。
sRCC患者的总体预后较差，复发率和死亡率较高，这表明需要更有效的全身治疗。在非转移性患者中，将%Sarc纳入预测列线图可能会进一步改善风险分层。
