This was a retrospective study that identified patients with sarcomatoid renal cell carcinoma who underwent nephrectomy and received systemic therapy from 1987 – 2005. Demographics, clinical features, performance status, symptoms at diagnosis, laboratory values, operative notes, pathological features, postoperative evaluation, systemic therapies and follow-up were recorded for CCI calculations. Systemic therapies were grouped as targeted, immunotherapy chemotherapy, or combinations (combination group consisted of 2 subgroups). For statistical analysis, multivariate regression models were used to determine the association with survival.
In total, 199 patients with sRCC were identified (mean age, 57). 92% of patients were symptomatic at initial diagnosis, and 69% presented with metastatic disease at initial diagnosis. 167 patients (83.9%) of the study population died, with mean overall survival of 16.5 months. The researchers found that survival of patients with clear histology was significantly longer vs those with non clear cell histology, and patients with synchronous metastatic disease had significantly shorter survival than patients with metachronous metastatic disease. Significant improvement in survival rate was observed in first year patients treated in targeted therapy era, but disappeared at years 3 to 5 after diagnosis and was not evident in patients with poor risk features.
The authors noted that some limitations in the study include retrospective nature and heterogenous systemic therapies that patients received during the years. However, they controlled for several clinical and pathological variables known to influence survival outcomes. In conclusion, the survival of patients with advanced sRCC without poor risk features who underwent nephrectomy steadily improves; however, survival does not extend beyond the first 2 years. Thus, there is still a poor prognosis for sRCC with no clear long-term benefit of target therapy. Future studies need to be done to develop more effective systemic therapies for these patients.
Written by: Zhamshid Okhunov, University of CA, Irvine
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