NEW ORLEANS, LA USA (UroToday.com) - In today’s podium session on surgical therapy for kidney cancer, Dr. Daniel Moreira presented clinicopathologic characteristics and survival for patients with renal sarcoma. Primary renal sarcoma makes up approximately 1% of renal tumors, and consequently there is limited data on the optimal treatment for these patients. Dr. Moreira’s group reviewed SEER data from 1973-2011 and identified 489 renal sarcomas. Their primary outcome of interest was CSS.
The median age of the series was 61-years. 52% of patients were female and 48% were male. 81% of patients were Caucasian. Median tumor size was 11cm. Analysis of histologic subtype demonstrated that 34% of tumors were leiomyosarcoma, 26% were liposarcoma, 17% were unknown, 14% were spindle-cell, 11% were “other,” 6% were malignant fibrous histiocytoma, and 3% were fibrosarcoma. There were equal proportions of metastatic, locally advanced, and localized tumors. 36% of patients had high-grade lesions, 18% were low grade, and 46% were unknown. Regarding treatment, 53% of those with localized disease underwent nephrectomy, while 24% of those with metastatic disease underwent cytoreductive nephrectomy.
There was a 60% CSS at 5 years for patients with nonmetastatic disease, vs <20% in those with metastases (p < 0.001). When stratified by treatment, patients who had surgery, or surgery and radiation, had significantly higher CSS than those who received radiation alone or no treatment (p=0.036 for localized, p=0.008 for metastatic).
Predictors of survival among patients with localized disease were age (HR 1.02, p=0.03), non-white race (HR 0.54, p=0.04), tumor size (HR1.04, p=0.002), and high-grade disease (HR 4.33, p < 0.001). Treatment also predicted survival, as those who underwent surgery (HR 0.34) or surgery and radiation (HR0.22) had better CSS (p=0.007) compared to no treatment.
Among patients with metastatic disease, non-white race (HR 0.46, p=0.02), and histologic subtype (HR 0.42, p=0.02) predicted CSS. Those who underwent surgery alone (HR 0.38) or surgery and radiation (HR 0.22) had improved CSS over no treatment (p=0.02).
Dr. Moreira concluded that metastatic adult renal sarcoma carries an ominous prognosis, but that durable survival may be achieved in localized tumors. Stage, histology, grade, and size correlate with cancer-specific survival. Surgical resection is associated with an improved cancer-specific survival in both non-metastatic and metastatic patients.
Presented by Daniel Moreira at the American Urological Association (AUA) Annual Meeting - May 15 - 19, 2015 - New Orleans, LA USA
Mayo Clinic, Rochester, MN USA
Reported by Nikhil Waingankar, medical writer for UroToday.com