Wang Luke L, Puri Dhruv, Saitta Cesare, Liu Franklin, Afari Jonathan A, Meagher Margaret F, Hakimi Kevin, Nguyen Mimi V, Shah Aastha, Ghassemzadeh Saeed, Murphy James D, Javier-Desloges Juan, McKay Rana R, Derweesh Ithaar H
Department of Urology, University of California-San Diego School of Medicine, La Jolla, CA, USA.
IRCCS Humanitas Clinical and Research Hospital, Rozzano, Italy.
Eur Urol Open Sci. 2024 Dec 13;71:96-105. doi: 10.1016/j.euros.2024.10.002. eCollection 2025 Jan.
Our aim was to determine the clinical characteristics, temporal trends, and survival outcomes for sarcomatoid-dedifferentiated renal cell carcinoma (sRCC), as sRCC has historically had poor prognosis and a contemporary cohort has not been well characterized in a population-based study.
Data for 302 630 RCC cases from 2010 to 2019 were extracted from the National Cancer Data Base, of which 4.1% (12 329) were sRCC. Trend analyses were conducted using the Cochran-Armitage test. Multivariable analyses were used to assess factors associated with sRCC diagnosis and clinicopathologic characteristics associated with all-cause mortality (ACM). Overall survival (OS) was computed via Kaplan-Meier analysis.
sRCC incidence increased from 3.9% in 2010 to 4.1% in 2019 ( = 0.020). The incidence of stage I sRCC increased from 14.5% in 2010 to 19.2% in 2019 ( < 0.001). sRCC diagnosis was associated with male sex, tumor size, cN1 status, and collecting duct histology. Worse ACM in localized sRCC was associated with age, tumor size, cN1 stage, collecting duct histology, and positive surgical margins; and was inversely associated with partial nephrectomy (hazard ratio [HR] 0.61, 95% confidence interval [CI] 0.49-0.76; < 0.001). Worse ACM in metastatic sRCC was associated with age, tumor size, cN1, collecting duct histology, positive surgical margins, and no surgery at the primary site (HR 1.66, 95% CI 1.20-2.30; = 0.006). The 5-yr OS rates for stage I, stage II, stage III, and stage IV sRCC were 74%, 63%, 42%, and 16%, respectively ( < 0.001).
The proportion of sRCC cases overall and of stage I sRCC cases increased from 2010 to 2019, supporting the hypothesis of stage migration and the potential for early sarcomatoid dedifferentiation. Further studies on the causal mechanisms underpinning better survival after partial nephrectomy in localized disease and after cytoreductive surgery in metastatic disease are warranted.
We analyzed trends and outcomes for a type of aggressive kidney cancer (sarcomatoid renal cell carcinoma, sRCC) using records from the National Cancer Data Base. We found that the percentage of sRCC cases among all kidney cancers increased from 2010 to 2019. Factors such as tumor size and patient age were linked to worse survival. Surgery to remove the cancer was linked to better survival.
我们的目的是确定肉瘤样去分化肾细胞癌（sRCC）的临床特征、时间趋势和生存结局，因为sRCC历来预后较差，且在一项基于人群的研究中，当代队列尚未得到充分描述。
从国家癌症数据库中提取了2010年至2019年302630例肾细胞癌病例的数据，其中4.1%（12329例）为sRCC。使用 Cochr an-Armitage检验进行趋势分析。多变量分析用于评估与sRCC诊断相关的因素以及与全因死亡率（ACM）相关的临床病理特征。通过Kaplan-Meier分析计算总生存期（OS）。
sRCC的发病率从2010年的3.9%增至2019年的4.1%（P = 0.020）。I期sRCC的发病率从2010年的14.5%增至2019年的19.2%（P < 0.001）。sRCC诊断与男性、肿瘤大小、cN1状态和集合管组织学相关。局限性sRCC中较差的ACM与年龄、肿瘤大小、cN1分期、集合管组织学和手术切缘阳性相关；与部分肾切除术呈负相关（风险比[HR] 0.61，95%置信区间[CI] 0.49 - 0.76；P < 0.001）。转移性sRCC中较差的ACM与年龄、肿瘤大小、cN1、集合管组织学、手术切缘阳性以及原发部位未手术相关（HR 1.66，95% CI 1.20 - 2.30；P = 0.006）。I期、II期、III期和IV期sRCC的5年OS率分别为74%、63%、42%和16%（P < 0.001）。
2010年至2019年，sRCC病例总数及I期sRCC病例的比例均有所增加，支持分期迁移假说以及早期肉瘤样去分化的可能性。有必要进一步研究局部疾病行部分肾切除术后以及转移性疾病行减瘤手术后生存改善的因果机制。
我们使用国家癌症数据库中的记录分析了一种侵袭性肾癌（肉瘤样肾细胞癌，sRCC）的趋势和结局。我们发现2010年至2019年所有肾癌中sRCC病例的百分比有所增加。肿瘤大小和患者年龄等因素与较差的生存率相关。切除癌症的手术与较好的生存率相关。
