Zhi Hong, Feng Meiling, Liu Suo, Na Ta, Zhang Nandong, BiLiGe WuEn
Department of Mongolian Medicine Urology, Affiliated Hospital of Inner Mongolia University for Nationalities, Tongliao, China.
Department of Mongolian Medicine Stomatology, Affiliated Hospital of Inner Mongolia University for Nationalities, Tongliao, China.
Front Oncol. 2020 Oct 8;10:591001. doi: 10.3389/fonc.2020.591001. eCollection 2020.
To date, the prognostic value of sarcomatoid differentiation in patients having metastatic renal cell carcinoma (mRCC) remains inconclusive. A systematic review and meta-analysis were conducted.
Relevant literatures were obtained from PubMed, Embase, and Cochrane Library published prior to May, 2020. All patients were diagnosed with mRCC and treated with surgery, cytokine therapy, targeted therapy, and immunotherapy. Sarcomatoid differentiation in the pathological specimens was identified. Each endpoint [overall survival (OS), progression-free survival (PFS), and cancer-specific survival (CSS)] was assessed using a multivariable adjusted hazard ratio (HR) and 95% confidence interval (CI).
Fifteen observational studies having 5,828 patients with mRCC were included. The merged results showed that patients presenting sarcomatoid differentiation had a significantly inferior OS (HR: 2.26, 95% CI: 1.82-2.81; P < 0.001), PFS (HR: 2.28, 95% CI: 1.63-3.19; P < 0.001), and CSS (HR: 2.27, 95% CI: 1.51-3.40; P < 0.001) compared to those without sarcomatoid differentiation. Subgroup analysis based on publication year, patient population, country, number of cases, and NOS score did not change the direction of results. A significant publication bias was identified for OS, but no publication bias was identified for PFS. Moreover, sensitivity analysis also verified the robustness of the results.
This study suggested that sarcomatoid differentiation was correlated to unfavorable clinical outcomes in mRCC and may be a poor prognostic factor incorporating to prognostic models for mRCC patients.
迄今为止，肉瘤样分化在转移性肾细胞癌（mRCC）患者中的预后价值仍不明确。进行了一项系统评价和荟萃分析。
从2020年5月之前发表在PubMed、Embase和Cochrane图书馆的相关文献中获取资料。所有患者均被诊断为mRCC，并接受了手术、细胞因子治疗、靶向治疗和免疫治疗。对病理标本中的肉瘤样分化进行鉴定。使用多变量调整风险比（HR）和95%置信区间（CI）评估每个终点指标[总生存期（OS）、无进展生存期（PFS）和癌症特异性生存期（CSS）]。
纳入了15项观察性研究，共5828例mRCC患者。合并结果显示，出现肉瘤样分化的患者与未出现肉瘤样分化的患者相比，OS（HR：2.26，95%CI：1.82 - 2.81；P < 0.001）、PFS（HR：2.28，95%CI：1.63 - 3.19；P < 0.001）和CSS（HR：2.27，95%CI：1.51 - 3.40；P < 0.001）均显著较差。基于发表年份、患者群体、国家、病例数和NOS评分的亚组分析并未改变结果的方向。发现OS存在显著的发表偏倚，但PFS未发现发表偏倚。此外，敏感性分析也验证了结果的稳健性。
本研究表明，肉瘤样分化与mRCC患者不良临床结局相关，可能是mRCC患者预后模型中的一个不良预后因素。
