Prognostic implications of sarcomatoid and rhabdoid differentiation in patients with grade 4 renal cell carcinoma

• Published in: International urology and nephrology Vol. 48; no. 8; pp. 1253 - 1260
• Main Authors: Kara, Onder, Maurice, Matthew J., Zargar, Homayoun, Malkoc, Ercan, Akca, Oktay, Andrade, Hiury S., Ramirez, Daniel, Caputo, Peter A., Nelson, Ryan J., Rini, Brian, Kaouk, Jihad H.
• Format: Journal Article
• Language: English
• Published: Dordrecht Springer Netherlands 01.08.2016; Springer Nature B.V
• Subjects: Adult; Aged; Biopsy, Needle; Carcinoma, Renal Cell - mortality; Carcinoma, Renal Cell - pathology; Carcinoma, Renal Cell - surgery; Cause of Death; Cell Differentiation; Databases, Factual; Disease-Free Survival; Female; Humans; Immunohistochemistry; Kaplan-Meier Estimate; Kidney Neoplasms - mortality; Kidney Neoplasms - pathology; Kidney Neoplasms - surgery; Male; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Grading; Nephrectomy - methods; Nephrectomy - mortality; Nephrology; Prognosis; Proportional Hazards Models; Retrospective Studies; Rhabdoid Tumor - pathology; Risk Assessment; Sarcoma - pathology; Statistics, Nonparametric; Survival Rate; Urology; Urology - Original Paper; Rhabdoid differentiation; Renal cell carcinoma (RCC); Sarcomatoid differentiation; Prognostic
• ISSN: 0301-1623; 1573-2584
• DOI: 10.1007/s11255-016-1314-z

Objective Sarcomatoid and rhabdoid differentiation are associated with poor outcomes in renal cell carcinoma (RCC). We examined the impact of differentiation on cancer-specific survival (CSS) in surgically treated patients with grade 4 RCC. Materials and methods Using our institutional database of 1176 nephrectomies from 2005 to 2013, we identified patients with grade 4 RCC or any grade and the presence of sarcomatoid or rhabdoid differentiation. We divided the cohort based on differentiation: no differentiation, rhabdoid only, sarcomatoid only, and sarcomatoid and rhabdoid. CSS was analyzed using the Kaplan–Meier method and Cox proportional hazards modeling. Results Of 264 patients with grade 4 RCC, 159 (60.2 %) exhibited differentiation, including 45 (28.3 %) with rhabdoid only, 87 (54.7 %) with sarcomatoid only, and 27 (16.9 %) with rhabdoid and sarcomatoid. Sarcomatoid differentiation, either alone or with rhabdoid differentiation, was associated with worse median CSS than no differentiation (1.1 vs. 3.3 years, p  < 0.01, and 0.9 vs. 3.3 years, p  < 0.01, respectively). In patients with non-metastatic (HR 1.95, 95 % CI 1.19–3.19, p  = 0.008) and metastatic (HR 2.22, 95 % CI 1.45–3.41, p  < 0.001) RCC, sarcomatoid differentiation was associated with an increased risk of cancer-specific death. On multivariable analysis, sarcomatoid differentiation was an independent predictor of RCC death in patients with non-metastatic (HR 1.72, 95 % CI 1.04–2.84, p  = 0.03) and metastatic (HR 1.74, 95 % CI 1.05–2.90, p  = 0.03) disease. Rhabdoid differentiation alone was not associated with worse CSS ( p  = 0.55). Conclusions In grade 4 RCC, sarcomatoid differentiation is associated with increased mortality risk across all stages of disease. Rhabdoid differentiation is not associated with additional mortality risk.