The percentage abundance of sarcomatoid component has a prognostic role in grade 4 non-metastatic clear cell-renal carcinoma
Giuseppe Lucarelli, Francesco M. Lasorsa, Monica Rutigliano, Martina Milella, Marco Spilotros, Antonio d’Amati, Giuseppe Ingravallo, Felice Crocetto, Savio Domenico Pandolfo, Marco Fabiano, Matteo Ferro, Riccardo Autorino, Michele Battaglia, P. Ditonno
Abstract
PURPOSE: Sarcomatoid dedifferentiation represents one of the most aggressive features of clear cell renal cell carcinoma (ccRCC). In this study we evaluated whether grade 4-ccRCC subclassification based on the intratumoral abundance of sarcomatoid features could have a prognostic impact. METHODS: A cohort of 212 patients with localized or locally advanced sarcomatoid ccRCC was identified. This population was stratified according to abundance of sarcomatoid features in low-sarcomatoid (LS = < 20% sarcomatoid component; n = 117) and high-sarcomatoid (HS = ≥ 20% sarcomatoid component; n = 95). Estimates of cancer-specific survival (CSS) and recurrence-free survival (RFS) were calculated according to the Kaplan-Meier method and compared with the log-rank test. Multivariable analysis was performed using the Cox proportional hazards regression model to identify the most significant variables for predicting CSS and RFS. RESULTS: Kaplan-Meier survival curves stratified by abundance of sarcomatoid component, showed that CSS and RFS were significantly decreased in patients with sarcomatoid component ≥ 20% (both P < 0.0001). At multivariable analysis by Cox regression modeling, the abundance of sarcomatoid component was an independent adverse prognostic factor for CSS (P < 0.0001) and RFS (P < 0.0001). CONCLUSION: ccRCC Subclassification based on the abundance of intratumoral sarcomatoid component has a clinical significance. Our study showed that ccRCC subclassification into HS versus LS groups had a prognostic impact in terms of CSS and RFS in non-metastatic ccRCC.