Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA.
Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Cancer Imaging. 2023 Feb 15;23(1):16. doi: 10.1186/s40644-023-00535-0.
To evaluate MRI features of sarcomatoid renal cell carcinoma (RCC) and their association with survival.
This retrospective single-center study included 59 patients with sarcomatoid RCC who underwent MRI before nephrectomy during July 2003-December 2019. Three radiologists reviewed MRI findings of tumor size, non-enhancing areas, lymphadenopathy, and volume (and percentage) of T2 low signal intensity areas (T2LIA). Clinicopathological factors of age, gender, ethnicity, baseline metastatic status, pathological details (subtype and extent of sarcomatoid differentiation), treatment type, and follow-up were extracted. Survival was estimated using Kaplan-Meier method and Cox proportional-hazards regression model was used to identify factors associated with survival.
Forty-one males and eighteen females (median age 62 years; interquartile range 51-68) were included. T2LIAs were present in 43 (72.9%) patients. At univariate analysis, clinicopathological factors associated with shorter survival were: greater tumor size (> 10 cm; HR [hazard ratio] = 2.44, 95% CI 1.15-5.21; p = 0.02), metastatic lymph nodes (present; HR = 2.10, 95% CI 1.01-4.37; p = 0.04), extent of sarcomatoid differentiation (non-focal; HR = 3.30, 95% CI 1.55-7.01; p < 0.01), subtypes other than clear cell, papillary, or chromophobe (HR = 3.25, 95% CI 1.28-8.20; p = 0.01), and metastasis at baseline (HR = 5.04, 95% CI 2.40-10.59; p < 0.01). MRI features associated with shorter survival were: lymphadenopathy (HR = 2.24, 95% CI 1.16-4.71; p = 0.01) and volume of T2LIA (> 3.2 mL, HR = 4.22, 95% CI 1.92-9.29); p < 0.01). At multivariate analysis, metastatic disease (HR = 6.89, 95% CI 2.79-16.97; p < 0.01), other subtypes (HR = 9.50, 95% CI 2.81-32.13; p < 0.01), and greater volume of T2LIA (HR = 2.51, 95% CI 1.04-6.05; p = 0.04) remained independently associated with worse survival.
T2LIAs were present in approximately two thirds of sarcomatoid RCCs. Volume of T2LIA along with clinicopathological factors were associated with survival.
评估肉瘤样肾细胞癌（RCC）的 MRI 特征及其与生存的关系。
本回顾性单中心研究纳入了 2003 年 7 月至 2019 年 12 月期间在肾切除术前行 MRI 检查的 59 例肉瘤样 RCC 患者。3 位放射科医生回顾了肿瘤大小、非增强区、淋巴结病和 T2 低信号强度区（T2LIA）体积（和百分比）的 MRI 表现。提取了年龄、性别、种族、基线转移状态、病理细节（亚型和肉瘤样分化程度）、治疗类型和随访等临床病理因素。采用 Kaplan-Meier 法估计生存情况，采用 Cox 比例风险回归模型确定与生存相关的因素。
纳入 41 名男性和 18 名女性（中位年龄 62 岁；四分位距 51-68）。43 例（72.9%）患者存在 T2LIA。单因素分析显示，与生存时间较短相关的临床病理因素包括：肿瘤较大（>10cm；HR[危险比]2.44，95%CI 1.15-5.21；p=0.02）、存在转移淋巴结（HR2.10，95%CI 1.01-4.37；p=0.04）、肉瘤样分化程度不局限（HR3.30，95%CI 1.55-7.01；p<0.01）、非透明细胞型、乳头状或嫌色细胞型以外的亚型（HR3.25，95%CI 1.28-8.20；p=0.01）以及基线转移（HR5.04，95%CI 2.40-10.59；p<0.01）。与生存时间较短相关的 MRI 特征包括：淋巴结病（HR2.24，95%CI 1.16-4.71；p=0.01）和 T2LIA 体积（>3.2mL，HR4.22，95%CI 1.92-9.29；p<0.01）。多因素分析显示，转移疾病（HR6.89，95%CI 2.79-16.97；p<0.01）、其他亚型（HR9.50，95%CI 2.81-32.13；p<0.01）和较大的 T2LIA 体积（HR2.51，95%CI 1.04-6.05；p=0.04）与生存较差独立相关。
约三分之二的肉瘤样 RCC 存在 T2LIA。T2LIA 体积以及临床病理因素与生存有关。
