Does postoperative radiation therapy impact survival in non-metastatic sarcomatoid renal cell carcinoma? A SEER-based study

• Published in: International urology and nephrology Vol. 47; no. 10; pp. 1653 - 1663
• Main Authors: Eminaga, Okyaz, Akbarov, Ilgar, Wille, Sebastian, Engelmann, Udo
• Format: Journal Article
• Language: English
• Published: Dordrecht Springer Netherlands 01.10.2015; Springer Nature B.V
• Subjects: Adult; Aged; Aged, 80 and over; Carcinoma, Renal Cell - mortality; Carcinoma, Renal Cell - pathology; Carcinoma, Renal Cell - radiotherapy; Carcinoma, Renal Cell - surgery; Disease-Free Survival; Female; Humans; Kaplan-Meier Estimate; Kidney Neoplasms - mortality; Kidney Neoplasms - pathology; Kidney Neoplasms - radiotherapy; Kidney Neoplasms - surgery; Male; Medicine; Medicine & Public Health; Middle Aged; Nephrectomy - methods; Nephrology; Radiotherapy, Adjuvant - mortality; Regression Analysis; SEER Program; Survival Rate; Ureter - surgery; Urinary Bladder - surgery; Urology; Urology - Original article; Young Adult; SEER; Radiation therapy; Sarcomatoid renal cell carcinoma; Disease-specific survival; Renal cell carcinoma; Outcome
• ISSN: 0301-1623; 1573-2584
• DOI: 10.1007/s11255-015-1093-y

Introduction The effect of adjuvant radiation therapy on survival in sarcomatoid renal cell carcinoma (sRCC) with no evidence of distant metastasis remains unclear. Methods Subjects diagnosed with non-metastatic sRCC were identified using the Surveillance Epidemiology and End Results (SEER) (2004–2012) database and divided into groups based on their surgical treatment (ST): no surgery or radiation therapy (NSR); partial nephrectomy (PNE); radical nephrectomy with ureterectomy and bladder cuff resection (RNE + UE + BLAD); and radical nephrectomy (RNE). Certain radical nephrectomy cases also received adjuvant external-beam radiation therapy (RNE + RAD). The Kaplan–Meier method was used to estimate overall survival (OS). A multivariable competing risks regression analysis was used to calculate disease-specific survival (DSS) probability and to determine factors associated with cause-specific mortality (CSM). Results A total of 408 patients were included in this study. The 5-year OS and predicted DSS were significantly higher in the patients who underwent STs (i.e., PNE, RNE + UE + BLAD, RNE, and RNE + RAD) (20.1–54.0 and 20.1–59.9 %, respectively) than in the NSR group (9.0 and 11.6 %, respectively) ( P  < 0.001). ST was independently associated with a decreased CSM ( P  < 0.0001). No significant differences in OS or the 1-, 3-, or 5-year DSS probabilities between the RNE and RNE + RAD groups were observed. RNE + RAD was not significantly associated with a decrease in 1-year CSM [subhazard ratio (SHR) 0.95; 95 % CI 0.23–3.96; P  = 0.947]. Conclusions Adjuvant external-beam radiation therapy did not increase OS in non-metastatic sRCC patients.