Abstract
BackgroundSarcomatoid differentiation in renal cell carcinoma (RCC) with vena caval tumour thrombus has been shown to be associated with aggressive behaviours and poor prognosis; however, evidence of the impact of rhabdoid differentiation on prognosis is lacking. This study evaluated the impact of sarcomatoid differentiation and rhabdoid differentiation on oncological outcomes for RCC with vena caval tumour thrombus treated surgically.MethodsWe retrospectively analysed patients treated surgically for RCC with vena caval tumour thrombus at our institute from Jan 2015 to Nov 2018. Prognostic variables were evaluated for associations with progression-free survival (PFS) and cancer-specific survival (CSS) by Kaplan–Meier survival analysis and log-rank test. Univariate and multivariate analyses were performed to determine independent prognostic variables.ResultsWe identified 125 patients with RCC and vena caval tumour thrombus, including 17 (13.6%) with sarcomatoid differentiation alone, 8 (6.4%) with rhabdoid differentiation alone and 3 (2.4%) with both sarcomatoid and rhabdoid differentiation. Compared to pure RCC, patients with sarcomatoid differentiation but not rhabdoid differentiation have worse PFS (p = 0.018 and p = 0.095, respectively). The univariate and multivariate analyses both showed sarcomatoid differentiation as a significant predictor of PFS. Compared to pure RCC, patients with sarcomatoid differentiation (p = 0.002) and rhabdoid differentiation (p = 0.001) both had significantly worse CSS. The univariate analysis showed sarcomatoid differentiation, rhabdoid differentiation, metastasis and blood transfusion as significant predictors of CSS (All, p < 0.05). In the multivariate analysis, sarcomatoid differentiation (HR 3.90, p = 0.008), rhabdoid differentiation (HR 3.01, p = 0.042), metastasis (HR 3.87, p = 0.004) and blood transfusion (HR 1.34, p = 0.041) all remained independent predictors of CSS.ConclusionsSarcomatoid differentiation and rhabdoid differentiation are both independent predictors of poor prognosis in RCC with vena caval tumour thrombus treated surgically.
Highlights
Sarcomatoid differentiation in renal cell carcinoma (RCC) with vena caval tumour thrombus has been shown to be associated with aggressive behaviours and poor prognosis; evidence of the impact of rhabdoid differentiation on prognosis is lacking
Baseline characteristics A total of 125 patients treated surgically for RCC with vena caval tumour thrombus were included in our study
There was no significant difference in gender, age, thrombus level, histological subtype, T stage, nodal status or adjuvant target therapy between the patients with sarcomatoid and/or rhabdoid differentiation and the patients with pure RCC
Summary
Comprehensive clinical and pathological data was collected for each patient, including age, gender, tumour size, thrombus level, blood transfusion, TNM stage, histologic subtype, Fuhrman grade, tumour necrosis, sarcomatoid differentiation, rhabdoid differentiation and adjuvant target therapy of tyrosine kinase inhibitors. The level of tumour thrombus was assigned using the Mayo classification [12]. (c) For Mayo III tumour thrombus, the liver was mobilized to expose the hepatic portal vein before blocking the IVC. Progression-free survival (PFS) was calculated from the date of surgery to radiological evidence of tumour progression, death from any cause or the last follow-up. Cancer specific survival (CSS) was calculated from the date of surgery to death from RCC or the last follow-up. Statistical analysis Normally distributed continuous variables were reported as means and standard deviations. Two-tailed tests were used for all comparisons, and p < 0.05 was considered statistically significant
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