Zhang Lijin, Wu Bin, Zha Zhenlei, Zhao Hu, Feng Yejun
Department of Urology, Affiliated Jiang-Yin Hospital of the Southeast University Medical College, Jiang-Yin 214400, China.
Cancer Manag Res. 2018 Jun 22;10:1687-1703. doi: 10.2147/CMAR.S166710. eCollection 2018.
Numerous studies have demonstrated that sarcomatoid differentiation is linked to the risk of renal cell carcinoma (RCC). However, its actual clinicopathological impact remains inconclusive. Therefore, we undertook a meta-analysis to evaluate the pathologic and prognostic impacts of sarcomatoid differentiation in patients with RCC by assessing cancer-specific survival, overall survival, recurrence-free survival, progression-free survival, and cancer-specific mortality.
In accordance with the preferred reporting items for systematic reviews and meta-analysis statement, relevant studies were collected systematically from PubMed, Embase, and Web of Science to identify relevant studies published prior to January 2018. The pooled effects (hazard ratios, odds ratios, and standard mean differences) and 95% confidence intervals were calculated to investigate the association of sarcomatoid differentiation with cancer prognosis and clinicopathological features.
Thirty-five studies (N=11,261 patients [n=59-1,437 per study]) on RCC were included in this meta-analysis. Overall, the pooled analysis suggested that sarcomatoid differentiation was significantly associated with unfavorable cancer-specific survival (HR=1.46, 95% CI: 1.26-1.70, <0.001), overall survival (HR=1.59, 95% CI: 1.42-1.78, <0.001), progression-free survival (HR=1.61, 95% CI: 1.35-1.91, <0.001), recurrence-free survival (HR=1.60, 95% CI: 1.29-1.99, <0.001), and cancer-specific mortality (HR=2.36, 95% CI: 1.64-3.41, <0.001) in patients with RCC. Moreover, sarcomatoid differentiation was closely correlated with TNM stage (III/IV vs I/II: OR=1.84, 95% CI: 1.12-3.03, =0.017), Fuhrman grade (III/IV vs I/II: OR=8.37, 95% CI: 2.92-24.00, <0.001), lymph node involvement (N1 vs N0: OR=1.88, 95% CI: 1.08-3.28, =0.026), and pathological types (clear cell RCC-only vs mixed type: OR=0.48, 95% CI: 0.29-0.80, =0.005), but was not related to gender (male vs female, OR=0.86, 95% CI: 0.58-1.28, =0.464) and average age (SMD=-0.02, 95% CI: -0.20-0.17, =0.868).
This study suggests that sarcomatoid differentiation in histopathology is associated with poor clinical outcome and advanced clinicopathological features in RCC and could serve as a poor prognostic factor for RCC patients.
大量研究表明，肉瘤样分化与肾细胞癌（RCC）的风险相关。然而，其实际的临床病理影响仍不明确。因此，我们进行了一项荟萃分析，通过评估癌症特异性生存、总生存、无复发生存、无进展生存和癌症特异性死亡率，来评价肉瘤样分化对RCC患者的病理及预后影响。
按照系统评价和荟萃分析报告的首选项目声明，从PubMed、Embase和Web of Science系统收集相关研究，以识别2018年1月之前发表的相关研究。计算合并效应（风险比、比值比和标准化均数差）及95%置信区间，以研究肉瘤样分化与癌症预后及临床病理特征之间的关联。
本荟萃分析纳入了35项关于RCC的研究（N = 11261例患者[每项研究n = 59 - 1437例]）。总体而言，汇总分析表明，肉瘤样分化与RCC患者不良的癌症特异性生存（HR = 1.46，95%CI：1.26 - 1.70，P < 0.001）、总生存（HR = 1.59，95%CI：1.42 - 1.78，P < 0.001）、无进展生存（HR = 1.61，95%CI：1.35 - 1.91，P < 0.001）、无复发生存（HR = 1.60，95%CI：1.29 - 1.99，P < 0.001）及癌症特异性死亡率（HR = 2.36，95%CI：1.64 - 3.41，P < 0.001）显著相关。此外，肉瘤样分化与TNM分期（III/IV期vs I/II期：OR = 1.84，95%CI：1.12 - 3.03，P = 0.017）、Fuhrman分级（III/IV级vs I/II级：OR = 8.37，95%CI：2.92 - 24.00，P < 0.001）、淋巴结受累（N1 vs N0：OR = 1.88，95%CI：1.08 - 3.28，P = 0.026）及病理类型（仅透明细胞RCC vs 混合型：OR = 0.48，95%CI：0.29 - 0.80，P = 0.005）密切相关，但与性别（男性vs女性，OR = 0.86，95%CI：0.58 - 1.28，P = 0.464）和平均年龄（SMD = -0.02，95%CI： - 0.20 - 0.17，P = 0.868）无关。
本研究表明，组织病理学中的肉瘤样分化与RCC患者不良的临床结局及晚期临床病理特征相关，可作为RCC患者预后不良的一个因素。
