Department of Oncology, Mayo Clinic, Rochester, MN, USA.
Department of Pathology, Mayo Clinic, Rochester, MN, USA.
Eur Urol. 2015 Jul;68(1):5-7. doi: 10.1016/j.eururo.2015.01.002. Epub 2015 Jan 28.
Renal cell carcinoma (RCC) with rhabdoid differentiation is thought to portend a poor prognosis, similar to RCC with sarcomatoid differentiation. Both features are currently classified as grade 4 RCC based on the most recent International Society of Urological Pathology (ISUP) grading system. We reviewed a large series of patients with grade 4 RCC to determine the differential effects of rhabdoid and sarcomatoid differentiation on patient outcome. We identified 406 patients with ISUP grade 4 RCC including 111 (27%) with rhabdoid differentiation. In multivariable analysis of grade 4 RCC tumors, the presence of rhabdoid differentiation was not associated with death from RCC (hazard ratio [HR]: 0.95; p=0.75); in contrast, sarcomatoid differentiation was significantly associated with death from RCC (HR: 1.63; p<0.001). Patients with RCC with rhabdoid differentiation were significantly more likely to die of RCC than a comparison cohort of 1758 patients with grade 3 RCC (HR: 2.45; p<0.001). The novel findings of our study suggest that rhabdoid and sarcomatoid differentiation should not be grouped together when assessing risk in a patient with grade 4 RCC but support the notion that rhabdoid differentiation is appropriately placed in the ISUP grade 4 category.
肾细胞癌（RCC）伴横纹肌样分化被认为预示着预后不良，类似于伴肉瘤样分化的 RCC。这两种特征目前根据最新的国际泌尿病理学会（ISUP）分级系统被归类为 4 级 RCC。我们回顾了一系列大量的 4 级 RCC 患者，以确定横纹肌样分化和肉瘤样分化对患者结局的不同影响。我们确定了 406 例 ISUP 分级 4 RCC 患者，其中 111 例（27%）有横纹肌样分化。在对 4 级 RCC 肿瘤的多变量分析中，横纹肌样分化的存在与 RCC 死亡无关（风险比[HR]：0.95；p=0.75）；相比之下，肉瘤样分化与 RCC 死亡显著相关（HR：1.63；p<0.001）。与 1758 例 3 级 RCC 患者的比较队列相比，有横纹肌样分化的 RCC 患者死于 RCC 的风险显著更高（HR：2.45；p<0.001）。我们研究的新发现表明，在评估 4 级 RCC 患者的风险时，不应将横纹肌样分化和肉瘤样分化归为一组，但支持横纹肌样分化适当归入 ISUP 4 级类别的观点。
