Survival outcomes of sarcomatoid renal cell cancer (sRCC) compared to clear cell renal cell cancer (ccRCC): An analysis of SEER data.

e17101 Background: Renal cell carcinoma (RCC) with sarcomatoid differentiation is a highly aggressive form of RCC. The presence of even a small component of sRCC was shown to independently predict poor survival compared to RCC without sarcomatoid features. We studied the epidemiology and survival outcome of sRCC compared to ccRCC by reviewing the SEER data. Methods: Patients (pts) with histologically confirmed sRCC and ccRCC between 2012-2015 were reviewed in SEER database. Variables included age, gender, ethnicity, histologic grade, stage at diagnosis, and nephrectomy. Primary outcome was 5 year Disease Specific Survival (DSS). Data was analyzed using Kaplan Meier curves and Cox proportional hazards model. Results: A total of 31, 293 pts with RCC were identified in SEER database between 2012 to 2015. 611 pts had sRCC while 30, 682 had ccRCC. The two groups had almost similar demographic features, including mean age (63 ±12 for sRCC vs 61±12 years for ccRCC), male: female ratio (vs 2.3:1 vs 1.7:1) and Caucasian ethnicity (82% vs 85%). More than half of sRCC patients (62%) were metastatic at diagnosis compared to only 11% of ccRCC, which presented most commonly as stage I disease (63%). The histologic grade was higher in sRCC patients (43% grade 4 vs 45% grade 2 in ccRCC subjects). Nephrectomy rates were almost similar for stages I-III in the two groups (94% in sRCC vs 93% in ccRCC) while lower in stage IV sRCC (44% vs 54%). Across all stages and at every time point, sRCC was associated with increased mortality in the univariate analysis. In the multivariate regression analysis (table), advanced stage was the strongest independent predictor of mortality (HR 11.9), followed by high histologic grade (HR 3.6) and sarcomatoid histology (HR 2.9). Nephrectomy was protective (HR 0.3). Age was associated with worse outcomes (HR 1.016 per unit change). Conclusions: sRCC are more aggressive and tend to present as metastatic disease. sRCC has worse outcomes across all stages compared to ccRCC even after adjusting for potential confounders. Advanced stage and histologic grade remain the two strongest predictors of disease-specific mortality, sarcomatoid histology demonstrated a significant impact on outcome. [Table: see text]

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Epidemiology and outcome of sarcomatoid renal cell cancer compared to clear cell renal cancer: A Surveillance, Epidemiology, and End Results (SEER) database review.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.4_suppl.504 ◽

2014 ◽

Vol 32 (4_suppl) ◽

pp. 504-504 ◽

Cited By ~ 1

Author(s):

Mohammed Nawaf Kanaan ◽

Parminder Singh ◽

Frederick R. Ahmann ◽

Amit Balkrishna Agarwal

Keyword(s):

Renal Cell ◽

Cell Cancer ◽

Case Series ◽

Stage Iv ◽

Stage I ◽

Stage Ii ◽

Main Stage ◽

Seer Database ◽

Female Ratio ◽

Significant Difference

504 Background: Sarcomatoid renal cell carcinoma (SRCCa) is a rare type of RCCa. Few case series in literature indicated its dismal prognosis. We studied the epidemiology and survival outcome of SRCCa compared to clear RCCa (CRCCa) by reviewing the SEER database. Methods: SEER database (8.1.2) was reviewed for patients (pts) with histologically confirmed SRCCa and CRCCa between 2004 -2007. Variables included were: age, race, gender, laterality, surgery of primary RCCa and AJCC stage. Primary outcome was 3 year Disease Specific Survival (DSS). Data was analyzed using Chi square, Kaplan Meier and Cox proportional hazard model. Results: A total of 7,653 pts with CRCCa and 540 with SRCCa were included between 2004 and 2007. Mean age in SRCCa was 61 compared to 62 yrs in CRCCa. White to black race ratio was 7.5:1 in both types. Left primary was 54% in SRCCa and 51% in CRCCa. Male to female ratio was 1.9:1 in SRCCa and 1.7:1 in CRCCa (Table). The main stage at presentation was stage IV (63%) in SRCCa and stage I (53%) in CRCCa. Surgery rate was higher in SRCCa in stage II and IV, same between two groups in stage II and higher in CRCCa in stage I. When we analyzed the effect of RCCa type on DSS for each stage separately, SRCCa had worse 3-year DSS in stage I, II, III and IV independent of age, sex, race, gender and surgery. The Hazard Ratio was 4.97 for stage I, 11.37 for stage II, 3.91 for stage III and 1.58 for stage IV (p <0.001). Conclusions: SRCCa have no statistical significant difference in age, race, gender and laterality compared to CRCCa. When compared stage to stage, SRCCa have worse outcome than RCCa even after adjusting for potential confounders including age, race, gender and surgery. The effect appears to be less prominent in higher stages than in lower stages of the disease. [Table: see text]

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Molecular profile of early-stage and advanced-stage of renal cell cancer in China.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e16071 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e16071-e16071

Author(s):

Jimin Chen ◽

Yanrui Zhang ◽

Tongtong Yang ◽

Huina Wang ◽

Jing Guo ◽

...

Keyword(s):

Renal Cell Cancer ◽

Renal Cell ◽

Early Stage ◽

Clinical Status ◽

Cell Cancer ◽

Genetic Alterations ◽

Molecular Profile ◽

Molecular Characteristics ◽

Advanced Stage ◽

Genomic Alterations

e16071 Background: The mutation spectrum has been extensively studied in Renal Cell Cancer (RCC), a heterogeneous disease. While major investigations have focused on metastatic RCC (mRCC). This study intended to explore the molecular characteristics between early-stage (stage I/Ⅱ) and advanced-stage (Ⅲ/Ⅳ) of RCC patients (pts). Methods: 36 tumor specimens were obtained from individual pts diagnosed RCC, including 22 tissues paired with blood samples. Somatic mutations were identified via targeted next generation sequencing with Acornmed panel including 808 genes associated with tumor development. Sequencing data were analyzed to call tumor specific single nucleotide variants (SNV), small insertions and deletions (InDels), copy number alterations (CNA) and chromosomal rearrangements. Clinical data of a cohort from TCGA who had RCC was collected and analyzed. Results: Among the 36 pts enrolled, 61% were early-stage group and 39% were advanced-stage group. The most frequently mutated genes in RCC were VHL (50%), PBRM1 (14%), BAP1 (11%), TP53 (11%) and PIK3CA (6%). Truncating mutations were the most frequent alterations accounting for 66% (33/50) of genetic alterations. Mutations in VHL, BAP1, PBRM1 and TP53 were shared by both early and advanced RCC. While mutations in PIK3CA, CDKN2C, EGFR, FAMCA, GRIN2A, KDM6A, SOX17, TSC1 and APC were only detected in early stage group. KNSTRN, KRAS, MYD88, NF2, ATM, PTEN and STAT5B mutations were only detected in advanced group. Among 22 plasma samples, genomic alterations were detected in 40.9% (9/22) of pts postoperatively, such as TP53, PIK3CA, PTEN, and APC. Functional annotation clustering revealed that 4/9 in these genes were tumor suppressors, which negatively regulated apoptosis. Pts with genomic alterations in TP53 (p = 0.0034), PIK3CA (p = 0.0015) or PTEN (p = 0.00017) had worse OS significantly (TCGA). Conclusions: VHL, PBRM1, BAP1 were the most important driver genes mainly detected in all stages of RCC. The heterogeneity between early and advanced-stage may be related with clinical status. Gene alterations in plasma ctDNA postoperatively should have the potential to stratify patients with different prognostic outcome.

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