肉瘤样分化和横纹肌样分化对手术治疗伴静脉癌栓的肾细胞癌预后的影响。
Impact of sarcomatoid differentiation and rhabdoid differentiation on prognosis for renal cell carcinoma with vena caval tumour thrombus treated surgically.
机构信息
Department of Urology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China.
Department of Pathology, Peking University Health Science Center, Beijing, China.
出版信息
BMC Urol. 2020 Feb 18;20(1):14. doi: 10.1186/s12894-020-0584-z.
BACKGROUND
Sarcomatoid differentiation in renal cell carcinoma (RCC) with vena caval tumour thrombus has been shown to be associated with aggressive behaviours and poor prognosis; however, evidence of the impact of rhabdoid differentiation on prognosis is lacking. This study evaluated the impact of sarcomatoid differentiation and rhabdoid differentiation on oncological outcomes for RCC with vena caval tumour thrombus treated surgically.
METHODS
We retrospectively analysed patients treated surgically for RCC with vena caval tumour thrombus at our institute from Jan 2015 to Nov 2018. Prognostic variables were evaluated for associations with progression-free survival (PFS) and cancer-specific survival (CSS) by Kaplan-Meier survival analysis and log-rank test. Univariate and multivariate analyses were performed to determine independent prognostic variables.
RESULTS
We identified 125 patients with RCC and vena caval tumour thrombus, including 17 (13.6%) with sarcomatoid differentiation alone, 8 (6.4%) with rhabdoid differentiation alone and 3 (2.4%) with both sarcomatoid and rhabdoid differentiation. Compared to pure RCC, patients with sarcomatoid differentiation but not rhabdoid differentiation have worse PFS (p = 0.018 and p = 0.095, respectively). The univariate and multivariate analyses both showed sarcomatoid differentiation as a significant predictor of PFS. Compared to pure RCC, patients with sarcomatoid differentiation (p = 0.002) and rhabdoid differentiation (p = 0.001) both had significantly worse CSS. The univariate analysis showed sarcomatoid differentiation, rhabdoid differentiation, metastasis and blood transfusion as significant predictors of CSS (All, p < 0.05). In the multivariate analysis, sarcomatoid differentiation (HR 3.90, p = 0.008), rhabdoid differentiation (HR 3.01, p = 0.042), metastasis (HR 3.87, p = 0.004) and blood transfusion (HR 1.34, p = 0.041) all remained independent predictors of CSS.
CONCLUSIONS
Sarcomatoid differentiation and rhabdoid differentiation are both independent predictors of poor prognosis in RCC with vena caval tumour thrombus treated surgically.
背景
肾细胞癌（RCC）伴静脉癌栓中出现肉瘤样分化与侵袭性行为和不良预后相关；然而，横纹肌样分化对预后的影响尚无证据。本研究评估了肉瘤样分化和横纹肌样分化对手术治疗的伴静脉癌栓 RCC 患者的肿瘤学结局的影响。
方法
我们回顾性分析了 2015 年 1 月至 2018 年 11 月在我院接受手术治疗的伴静脉癌栓 RCC 患者。通过 Kaplan-Meier 生存分析和对数秩检验评估预后变量与无进展生存（PFS）和癌症特异性生存（CSS）的相关性。进行单因素和多因素分析以确定独立的预后因素。
结果
我们共纳入 125 例伴静脉癌栓 RCC 患者，其中 17 例（13.6%）为单纯肉瘤样分化，8 例（6.4%）为单纯横纹肌样分化，3 例（2.4%）为同时存在肉瘤样分化和横纹肌样分化。与单纯 RCC 相比，仅肉瘤样分化患者的 PFS 更差（p=0.018 和 p=0.095）。单因素和多因素分析均显示肉瘤样分化是 PFS 的显著预测因素。与单纯 RCC 相比，肉瘤样分化（p=0.002）和横纹肌样分化（p=0.001）患者的 CSS 均显著更差。单因素分析显示肉瘤样分化、横纹肌样分化、转移和输血是 CSS 的显著预测因素（均 p<0.05）。多因素分析显示肉瘤样分化（HR 3.90，p=0.008）、横纹肌样分化（HR 3.01，p=0.042）、转移（HR 3.87，p=0.004）和输血（HR 1.34，p=0.041）仍是 CSS 的独立预测因素。
结论
肉瘤样分化和横纹肌样分化均是手术治疗伴静脉癌栓 RCC 患者预后不良的独立预测因素。
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