Outcomes of Patients with Renal Cell Carcinoma and Sarcomatoid Dedifferentiation Treated with Nephrectomy and Systemic Therapies Over Three Decades: Comparison Between the Cytokine (1987-2005) and the Targeted Therapy (2006-2015) Eras
This is a retrospective study of patients with sarcomatoid renal cell carcinoma who had nephrectomy and received systemic therapy at our center in the cytokine era (1987-2005) or the targeted therapy era (2006-2015).
Multivariate regression models were used to determine the association of covariables with survival.
Among 199 patients with sarcomatoid renal cell carcinoma, 167 (83.9%) have died (median overall survival 16.5 months; 95% CI: 15.2, 20.9). Survival of patients with clear-cell histology was significantly longer vs. those with non-clear cell histology (p = 0.034). Patients with synchronous metastatic disease had a significantly shorter survival compared with patients with metachronous metastatic disease (median 12.1 months vs. 23.3 months; p = 0.0064). Biopsy of the primary tumor or a metastatic site could detect the presence of sarcomatoid features in only 7.5% of cases. Although a significant improvement in survival rate was observed in the first year for patients treated in the targeted therapy era (p = 0.011), this effect was attenuated at year 2, disappeared at years 3-5 after diagnosis, and was not evident in patients with poor risk features.
Patients with sarcomatoid renal cell carcinoma still have poor prognosis with no clear long-term benefit of targeted therapy, underscoring the need to develop more effective systemic therapies for these patients.
The Journal of urology. 2017 Apr 11 [Epub ahead of print]
Sarp K Keskin, Pavlos Msaouel, Kenneth R Hess, Kai-Jie Yu, Surena F Matin, Kanishka Sircar, Pheroze Tamboli, Eric Jonasch, Christopher G Wood, Jose A Karam, Nizar M Tannir
Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA., Department of Genitourinary Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA., Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA., Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Division of Urology, Department of Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan., Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA., Department of Genitourinary Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. Electronic address: .
PubMed http://www.ncbi.nlm.nih.gov/pubmed/28411072
Read an Expert Commentary on this abstract by Zhamshid Okhunov