Soytas Mustafa, Dragomir Alice, Sawaya Ghady Bou-Nehme, Hesswani Charles, Tanguay Maude, Finelli Antonio, Wood Lori, Rendon Ricardo, Bansal Rahul, Lalani Aly-Khan, Heng Daniel Y C, Bhindi Bimal, Basappa Naveen S, Dean Lucas, So Alan, Nayak Jasmir G, Bjarnason Georg, Breau Rodney, Lavallee Luke, Lattouf Jean-Baptiste, Pouliot Frederic, Bonert Michael, Tanguay Simon
Division of Urology, Department of Surgery, McGill University, Montréal, Quebec, Canada.
Department of Surgery, Faculty of Medicine and Health Sciences, McGill University, Montréal, Quebec, Canada.
BJU Int. 2025 May;135(5):818-827. doi: 10.1111/bju.16609. Epub 2024 Dec 4.
To evaluate and compare the outcomes of patients with localised renal cell carcinoma (RCC) with and without sarcomatoid features and the impact of this on cancer recurrence and survival.
The Canadian Kidney Cancer information system database was used to identify patients diagnosed with localised RCC between January 2011 and December 2022. Patients with pT1-T3, n Nx-N0N1, M0 stage and documented sarcomatoid status were included. Patients with sarcomatoid RCC were categorised according to the sarcomatoid component percentage (%Sarc). Inverse probability of treatment weighting scores were used to balance the groups. Cox proportional hazards models were used to assess the impact of sarcomatoid status and %Sarc on recurrence-free and overall survival.
A total of 6660 patients (201 with and 6459 without sarcomatoid features) with non-metastatic RCC were included. %Sarc data were available in 155 patients, and the median value was 10%. The weighted analysis revealed that the presence of sarcomatoid features was associated with an increased risk of developing metastasis and increased risk of mortality compared to absence of sarcomatoid features. A %Sarc value >10 was associated with an increased risk of developing metastasis and of mortality compared to a %Sarc value ≤10.
Patients with a %Sarc >10 have an increased risk of recurrence and mortality. These patients may benefit from a more stringent follow-up and %Sarc could represent an important criterion in the risk assessment for adjuvant therapy.
评估和比较具有和不具有肉瘤样特征的局限性肾细胞癌（RCC）患者的预后，以及这对癌症复发和生存的影响。
利用加拿大肾癌信息系统数据库，识别出2011年1月至2022年12月期间被诊断为局限性RCC的患者。纳入pT1-T3、n Nx-N0N1、M0期且有记录的肉瘤样状态的患者。肉瘤样RCC患者根据肉瘤样成分百分比（%Sarc）进行分类。使用治疗权重评分的逆概率来平衡各组。采用Cox比例风险模型评估肉瘤样状态和%Sarc对无复发生存期和总生存期的影响。
共纳入6660例非转移性RCC患者（201例有肉瘤样特征，6459例无肉瘤样特征）。155例患者有%Sarc数据，中位数为10%。加权分析显示，与无肉瘤样特征相比，存在肉瘤样特征与发生转移的风险增加和死亡风险增加相关。与%Sarc值≤10相比，%Sarc值>10与发生转移和死亡的风险增加相关。
%Sarc>10的患者复发和死亡风险增加。这些患者可能受益于更严格的随访，%Sarc可能是辅助治疗风险评估的一个重要标准。
