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Outcome of patients with metastatic sarcomatoid renal cell carcinoma: results from the International Metastatic Renal Cell Carcinoma Database Consortium

 Christos E. Kyriakopoulos  ;  Namita Chittoria  ;  Toni K. Choueiri  ;  Nils Kroeger  ;  Jae-Lyun Lee  ;  Sandy Srinivas  ;  Jennifer J. Knox  ;  Georg A. Bjarnason  ;  Scott D. Ernst  ;  Lori A. Wood  ;  Ulka N. Vaishampayan  ;  Neeraj Agarwal  ;  Sumanta K. Pal  ;  Ravindran Kanesvaran  ;  Sun-Young Rha  ;  Takeshi Yuasa  ;  Frede Donskov  ;  Scott A. North  ;  Daniel Y. Heng  ;  Brian I. Rini 
 CLINICAL GENITOURINARY CANCER, Vol.13(2) : 79-85, 2015 
Journal Title
Issue Date
Angiogenesis Inhibitors/therapeutic use* ; Antineoplastic Agents/therapeutic use* ; Carcinoma, Renal Cell/drug therapy* ; Carcinoma, Renal Cell/pathology ; Databases, Factual ; Humans ; Kidney Neoplasms/drug therapy* ; Kidney Neoplasms/pathology ; Molecular Targeted Therapy ; Neoplasm Metastasis ; Neoplasm Recurrence, Local/pathology* ; Retrospective Studies ; Treatment Outcome ; Vascular Endothelial Growth Factor A/antagonists & inhibitors
IMDC risk model ; Kidney cancer ; Overall survival ; Prognostication ; Targeted therapies
BACKGROUND: Sarcomatoid renal cell carcinoma is associated with poor prognosis. Data regarding outcome in the targeted therapy era are lacking. PATIENTS AND METHODS: Clinical, prognostic, and treatment parameters in metastatic renal cell carcinoma patients with and without sarcomatoid histology treated with targeted therapy were retrospectively analyzed. RESULTS: Two thousand two hundred eighty-six patients were identified (sRCC: n = 230 and non-sRCC: n = 2056). sRCC patients had significantly worse IMDC prognostic criteria compared with non-sRCC (11% vs. 19% favorable risk; 49% vs. 57% intermediate risk, and 40% vs. 24% poor risk; P < .0001). Time from original diagnosis to relapse (excluding synchronous metastatic disease) was shorter in the sRCC group (18.8 vs. 42.9 months; P < .0001). There was no significant difference in the incidence of central nervous system metastases (6%-8%) or underlying clear cell histology (87%-88%). More than 93% of patients received VEGF inhibitors as first-line therapy; objective response was less common in sRCC whereas primary refractory disease was more common (21% vs. 26% and 43% vs. 21%; P < .0001, for both). sRCC patients had significantly less use of second- (P = .018) and third-line (P < .0001) systemic therapy. The median progression-free survival (PFS)/overall survival (OS) was 4.5/10.4 months in sRCC patients and 7.8/22.5 months in non-sRCC patients (P < .0001 for both). Sarcomatoid histology was associated with a significantly worse PFS and OS after adjusting for individual IMDC risk factors in multivariable analysis (hazard ratio, 1.5; P < .0001 for both). CONCLUSION: Patients with sRCC have a shorter time to relapse, worse baseline prognostic criteria, and worse clinical outcome with targeted therapy. Additional insight into the biology of sRCC is needed to develop alternative therapeutics.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Rha, Sun Young(라선영) ORCID logo https://orcid.org/0000-0002-2512-4531
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