Janisch Florian, Kienapfel Christina, Fühner Constantin, Klotzbücher Thomas, Marks Phillip, Hillemacher Tobias, Meyer Christian P, Iwata Takehiro, Parizi Mehdi Kardoust, Sauter Guido, Fisch Margit, Shariat Shahrokh F, Dahlem Roland, Rink Michael
Department of Urology, Medical University of Hamburg, Hamburg, Germany.
Department of Urology, Medical University of Vienna, Vienna, Austria.
Front Surg. 2021 Nov 18;8:763271. doi: 10.3389/fsurg.2021.763271. eCollection 2021.
Sarcomatoid differentiation/histology of renal cell carcinoma (sRCC) in patients with metastatic renal cell carcinoma (mRCC) is still underresearched in current therapy regimes. We aimed to evaluate the impact of sRCC on outcomes in patients with mRCC treated with tyrosine kinase inhibitors (TKIs). We collected complete data of 262 consecutive mRCC patients from our institutional database for this retrospective study. All patients were treated with TKIs within a single or multimodal treatment approach. All analyses were adjusted for the presence of sRCC. Descriptive statistics as well as uni- and multivariable outcome metrics, including progression-free (PFS) and overall survival (OS) as endpoints were performed. Overall, 18 patients had sRCC (6.9%). Patients with sRCC had more often clear-cell histology ( = 0.047), a higher T-stage ( = 0.048), and underwent cytoreductive nephrectomy more frequently ( < 0.001). The most common first-line TKIs were Sunitinib (65.6%), Sorafenib (19.5%), and Pazopanib (10.3%), respectively. At a median follow-up of 32 months, patients with sRCC had significantly reduced PFS ( = 0.02) and OS ( = 0.01) compared to patients without sRCC. In multivariable analyses that adjusted for the effects of standard mRCC predictors, the sarcomatoid feature retained its independent association with inferior PFS (HR: 2.39; = 0.007) and OS (HR: 2.37; = 0.001). This association remained statistically significant in subgroup analyses of patients with Sunitinib as first-line therapy (PFS < 0.001; OS: < 0.001). Despite its rare occurrence, our findings confirm sRCC as a powerful predictor for inferior outcomes in mRCC treated with targeted therapies. This suggests a need for more tailored treatment strategies in patients harboring mRCC with sarcomatoid histology to improve oncological outcomes.
在当前治疗方案中，转移性肾细胞癌（mRCC）患者的肾细胞癌肉瘤样分化/组织学（sRCC）仍未得到充分研究。我们旨在评估sRCC对接受酪氨酸激酶抑制剂（TKIs）治疗的mRCC患者预后的影响。我们从机构数据库中收集了262例连续mRCC患者的完整数据用于这项回顾性研究。所有患者均采用单一或多模式治疗方法接受TKIs治疗。所有分析均针对sRCC的存在进行了调整。进行了描述性统计以及单变量和多变量结局指标分析，包括以无进展生存期（PFS）和总生存期（OS）作为终点。总体而言，18例患者患有sRCC（6.9%）。sRCC患者更常具有透明细胞组织学（P = 0.047），T分期更高（P = 0.048），并且更频繁地接受减瘤性肾切除术（P < 0.001）。最常见的一线TKIs分别是舒尼替尼（65.6%）、索拉非尼（19.5%）和帕唑帕尼（10.3%）。在中位随访32个月时，与无sRCC的患者相比，sRCC患者的PFS（P = 0.02）和OS（P = 0.01）显著降低。在针对标准mRCC预测因素的影响进行调整的多变量分析中，肉瘤样特征与较差的PFS（HR：2.39；P = 0.007）和OS（HR：2.37；P = 0.001）保持独立关联。在以舒尼替尼作为一线治疗的患者亚组分析中，这种关联在统计学上仍然显著（PFS < 0.001；OS：< 0.001）。尽管sRCC发生率较低，但我们的研究结果证实其是接受靶向治疗的mRCC患者预后较差的有力预测指标。这表明对于患有肉瘤样组织学的mRCC患者，需要更具针对性的治疗策略以改善肿瘤学结局。
