Hematology/Oncology Division, Beth Israel Deaconess Medical Center, Boston, MA.
Department of Surgery, Eastern Virginia Medical School, Norfolk, VA.
Clin Genitourin Cancer. 2023 Feb;21(1):155-161. doi: 10.1016/j.clgc.2022.07.012. Epub 2022 Jul 30.
Renal sarcomas are exceedingly rare and lack a prognostic stage classification. We thus aimed to investigate the contemporary clinicopathologic characteristics and outcomes of renal sarcomas at a national level.
We utilized the Surveillance, Epidemiology, and End Results database to extract data on patients with renal sarcoma diagnosed between 2004 and 2015. We estimated median, 1-, 3-, and 5-year overall survival (OS) probabilities via Kaplan-Meier curves and used multivariable regression to compare OS between different patient groups.
We identified 365 patients; at diagnosis, 104 patients (28.5%) had stage I disease (T1N0M0), 133 patients (36.4%) patients had stage II disease (T2-4N0M0), and 117 patients (32.1%) patients had stage III disease (any T, N1, or M1). Median survival was 105 months (interquartile range [IQR], 29 - not reached) for stage I disease, 46 months (IQR 14-118 months) for stage II disease, 8 months (IQR 3-28 months) for stage III disease, and 32 months (IQR, 8-116 months) for the entire cohort. Patient age (hazard ratio [HR] for death [per year] 1.02, 95% confidence interval [95% CI] 1.00-1.04), stage (II vs. I: HR 1.71, 95% CI 1.00-2.92; III vs. I: HR 4.93, 95% CI 2.68-9.05), grade (grade 3 vs. grade 1: 3.07, 95% CI 1.18-8.00; grade 4 vs. grade 1: HR 3.66, 95% CI 1.41-9.49), and possessing medical insurance (HR 0.40, 95% CI 0.16-0.94) were independently and significantly associated with OS. Performance of nephrectomy also trended towards independently improving OS (HR 0.23, 95% CI 0.05-1.09).
A novel staging classification for renal sarcomas into a 3-stage system based on Tumor Node Metastasis (TNM) criteria produces distinct survival curves, although further studies are needed to robustly assess its validity.
肾肉瘤非常罕见，缺乏预后分期分类。因此，我们旨在从全国范围内研究肾肉瘤的当代临床病理特征和结局。
我们利用监测、流行病学和最终结果数据库提取了 2004 年至 2015 年间诊断为肾肉瘤的患者的数据。我们通过 Kaplan-Meier 曲线估计了中位、1 年、3 年和 5 年的总生存率（OS）概率，并使用多变量回归比较了不同患者组之间的 OS。
我们共确定了 365 例患者；在诊断时，104 例（28.5%）患者患有 I 期疾病（T1N0M0），133 例（36.4%）患者患有 II 期疾病（T2-4N0M0），117 例（32.1%）患者患有 III 期疾病（任何 T、N1 或 M1）。I 期疾病的中位生存期为 105 个月（四分位距 [IQR]，29-未达到），II 期疾病为 46 个月（IQR 14-118 个月），III 期疾病为 8 个月（IQR 3-28 个月），整个队列为 32 个月（IQR，8-116 个月）。患者年龄（每增加 1 岁死亡的风险比[HR]为 1.02，95%置信区间[95%CI]为 1.00-1.04）、分期（II 期 vs. I 期：HR 1.71，95%CI 1.00-2.92；III 期 vs. I 期：HR 4.93，95%CI 2.68-9.05）、分级（3 级 vs. 1 级：HR 3.07，95%CI 1.18-8.00；4 级 vs. 1 级：HR 3.66，95%CI 1.41-9.49）和医疗保险状况（HR 0.40，95%CI 0.16-0.94）与 OS 独立且显著相关。肾切除术的实施也显示出与 OS 改善趋势相关（HR 0.23，95%CI 0.05-1.09）。
根据肿瘤淋巴结转移（TNM）标准，对肾肉瘤进行的一种新的分期分类为 3 期系统，产生了明显的生存曲线，尽管需要进一步研究来稳健地评估其有效性。
