What is the prognosis of sarcomatoid renal cell carcinoma (SRCC)?

Updated: Mar 11, 2019
  • Author: Ronald J Cohen, MB, BCh, PhD, FRCPA, FFPATH; Chief Editor: Liang Cheng, MD  more...
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The 5-year cancer-specific survival rates for patients with SRCC are 15-27%, [2, 4, 7] compared with 79% for patients with clear cell renal cell carcinoma (CCRCC) showing no sarcomatoid change. [7] Most patients (80%) with SRCC who undergo nephrectomy for clinically localized disease subsequently present with metastatic disease. [3]

Multivariate analyses of RCC cases show that sarcomatoid differentiation is an independent predictor of poor prognosis even after adjustment for tumor stage, nuclear grade, and the presence of tumor necrosis or metastatic spread, all of which are also significant predictors. [2, 4, 15, 33] Some studies have found in univariate analysis that prognosis worsens as the percentage of sarcomatoid differentiation increases, particularly once it constitutes 50% or more of the tumor volume. [5, 7]

Multivariate analysis specifically of SRCC cases shows that only TNM stage conveys an independent risk of poor prognosis above that of sarcomatoid differentiation. In contrast, Fuhrman nuclear grade, tumor size, angiolymphatic invasion, percentage of sarcomatoid component, and underlying RCC subtype do not have independent predictive value. [7]

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