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The Natural History of Renal-Cell Carcinoma with sarcomatoid differentiation, a Stage-by-Stage Analysis

  • Author Footnotes
    # denotes equal contribution
    Karl H. Tully
    Correspondence
    Corresponding author: Matthew Mossanen, MD, Division of Urological Surgery, Brigham and Women's Hospital, 45 Francis St., ASB II–3, Boston, MA 02115. T: +1 617 525 7350; F: + 1 617 525 6348.
    Footnotes
    # denotes equal contribution
    Affiliations
    Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA

    Department of Urology and Neurourology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
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  • Author Footnotes
    # denotes equal contribution
    Sebastian Berg
    Correspondence
    Corresponding author: Matthew Mossanen, MD, Division of Urological Surgery, Brigham and Women's Hospital, 45 Francis St., ASB II–3, Boston, MA 02115. T: +1 617 525 7350; F: + 1 617 525 6348.
    Footnotes
    # denotes equal contribution
    Affiliations
    Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA

    Department of Urology and Neurourology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
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  • Marco Paciotti
    Affiliations
    Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA

    Department of Urology, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy
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  • Florian Janisch
    Affiliations
    Department of Urology, Medical University of Vienna, Vienna, Austria

    Department of Urology, Medical University of Hamburg, Hamburg, Germany
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  • Stephen W. Reese
    Affiliations
    Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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  • Joachim Noldus
    Affiliations
    Department of Urology and Neurourology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
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  • Shahrokh F. Shariat
    Affiliations
    Department of Urology, Medical University of Vienna, Vienna, Austria

    Department of Urology, Medical University of Hamburg, Hamburg, Germany

    Department of Urology, Weill Cornell Medical School, New York, NY, USA

    Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria

    Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic

    Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
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  • Toni Choueiri
    Affiliations
    Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
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  • Guido Müller
    Affiliations
    Department of Urology and Neurourology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany

    Center for Urological Rehabilitation, Kliniken Hartenstein, Bad Wildungen, Germany
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  • Bradley McGregor
    Affiliations
    Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
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  • Steven L. Chang
    Affiliations
    Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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  • Quoc-Dien Trinh
    Affiliations
    Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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  • Matthew Mossanen
    Correspondence
    Corresponding author: Matthew Mossanen, MD, Division of Urological Surgery, Brigham and Women's Hospital, 45 Francis St., ASB II–3, Boston, MA 02115. T: +1 617 525 7350; F: + 1 617 525 6348.
    Affiliations
    Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
    Search for articles by this author
  • Author Footnotes
    # denotes equal contribution
Published:November 23, 2022DOI:https://doi.org/10.1016/j.clgc.2022.11.015

      Abstract

      Purpose

      Sarcomatoid differentiation in patients diagnosed with renal cell carcinoma (sRCC) imply aggressive behavior and often metastatic disease at the time of diagnosis. We aim to examine the overall survival (OS) in patients with sRCC using the National Cancer Database (NCDB).

      Methods

      We identified patients diagnosed with sRCC between 2010-2015. We employed Kaplan-Meier curves and multivariable Cox proportional hazards regression models to examine the impact of several potential risk factors on OS in patients diagnosed with sRCC.

      Results

      In total, 8,582 patients with renal cancer were found to have sarcomatoid differentiation, with 4,105 patients (47.8%) being diagnosed with AJCC stage 4 disease. The median OS was 17.2 months (IQR 5.4, 68.7 months). Compared to patients who did not undergo surgery, OS was significantly longer in patients undergoing partial or total nephrectomy across all stages. This result remained consistent on multivariable Cox proportional hazards regression adjusting for patient and tumor characteristics (Surgery: Hazard ratio 0.54, 95%Confidence interval 0.43 – 0.68, p<0.001).

      Conclusion

      In our cohort sRCC was found to have an unfavorable median OS, which was mainly caused by the high number of cases diagnosed with late-stage disease. Additionally, surgery was associated with favorable OS across all stages. This study supports the notion that surgical therapy, even in the setting of cytoreductive surgery, provides a survival benefit in patients with sRCC.

      Micro Abstract

      In this retrospective study using the National Cancer DataBase, the unfavorable median overall survival in patients diagnosed with renal cell carcinoma with sarcomatoid differentiation was found to be caused by the high number of cases diagnosed with late-stage disease. Additionally, surgical therapy was associated with favorable overall survival across all stages.

      Keywords

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