Impact of Lymph Node Invasion and Sarcomatoid Differentiation on the Survival of Patients with Locally Advanced Renal Cell Carcinoma

Abstract

Introduction: The application of current prognosticators in locally advanced nonmetastatic renal cell carcinoma (RCC) is controversial. We analyzed the impact of clinical and pathological variables on the survival of this subset of patients. Patients and Methods: We studied patients with RCC in stages III and IV without metastases, treated surgically between 1980 and 2009. We calculated disease-free (DFS) and cancer-specific survival (CSS), and the relation of clinical and pathological variables with these end-points. Results: We identified 126 patients with locally advanced RCC; 8.7% had sarcomatoid differentiation. Tumor stage was pT3a in 48% and pT3b in 42%; 11.9% had lymph node invasion (N+). Patients with N– and N+ had a 10-year DFS of 49.0 and 23.4%, respectively (p = 0.0001). In multivariate analysis N+ (p = 0.0002) was the strongest predictor of DFS. The 10-year CSS of patients without sarcomatoid differentiation was 53.1% while those with sarcomatoid differentiation did not reach the median time to death (p < 0.0001). In multivariate analysis, sarcomatoid differentiation (p = 0.01) was the strongest predictor of CSS. Conclusions: Locally advanced RCC portends poor prognosis. Preoperatively, weight loss and Eastern Cooperative Oncology Group performance status are predictors of recurrence and mortality, respectively. However, the most powerful predictors of DFS and CSS in our cohort were lymph node status and sarcomatoid differentiation.

Time to Recurrence after Nephrectomy as a Predictor of Cancer-Specific Survival in Localized Clear-Cell Renal Cell Carcinoma

“…According to our results, patients with high-grade lesions, in stages pT3-4 and with diameters of 1 7 cm are at a higher risk of early recurrence. In addition, sarcomatoid differentiation, currently recognized as an adverse prognostic factor [16][17][18] , showed a trend toward association with the likelihood of early relapse. Based on our findings and those by other investigators [7] , we propose a risk-adapted surveillance protocol for these patients after surgery.…”

Brazilian data of renal cell carcinoma in a public university hospital

“…Some trials had assessed this issue with similar results. Interestingly, it was also observed in a Mexican trial that has assessed clinical and pathological aspects related to poor prognosis among patients with Stage III or IV RCC ( 14 ). In this study, 126 patients were included and 8.7% had sarcomatoid differentiation ( 14 ).…”

“…Interestingly, it was also observed in a Mexican trial that has assessed clinical and pathological aspects related to poor prognosis among patients with Stage III or IV RCC ( 14 ). In this study, 126 patients were included and 8.7% had sarcomatoid differentiation ( 14 ). After a multivariate Cox regression analysis, the risk of cancer-specific death was more than 3 times higher among individuals with sarcomatoid differentiation ( 14 ).…”

“…In this study, 126 patients were included and 8.7% had sarcomatoid differentiation ( 14 ). After a multivariate Cox regression analysis, the risk of cancer-specific death was more than 3 times higher among individuals with sarcomatoid differentiation ( 14 ). Lymph node invasion was also a poor prognostic factor; however, our trial did not evaluate this aspect.…”

Evaluation and Management of Small Renal Masses: Looking Beyond the Tumor Margin

“…Microscopy is then performed to determine the histologic type, nuclear grade, margin status, and to search for the presence of necrosis, sarcomatoid features, and/or lymphovascular invasion. Of note, the presence of sarcomatoid features is associated with adverse outcomes including up to a twofold increased risk in mortality [36,37]. In contrast, while the presence of lymphovascular invasion is associated with a worse outcome in several urologic malignancies, including urothelial carcinoma [38], its role in RCC is debatable.…”