Arun Z Thomas1, Mehrad Adibi1, Rebecca S Slack2, Leonardo D Borregales1, Megan M Merrill1, Pheroze Tamboli3, Kanishka Sircar3, Eric Jonasch4, Nizar M Tannir4, Surena F Matin1, Christopher G Wood1, Jose A Karam5. 1. Department of Urology, University of Texas M.D. Anderson Cancer Center, Houston, Texas. 2. Department of Biostatistics, University of Texas M.D. Anderson Cancer Center, Houston, Texas. 3. Department of Pathology, University of Texas M.D. Anderson Cancer Center, Houston, Texas. 4. Department of Genitourinary Medical Oncology, University of Texas M.D. Anderson Cancer Center, Houston, Texas. 5. Department of Urology, University of Texas M.D. Anderson Cancer Center, Houston, Texas. Electronic address: JAKaram@mdanderson.org.
Abstract
PURPOSE: Management of metastatic renal cell carcinoma with sarcomatoid dedifferentiation remains a therapeutic challenge with no standard treatment strategies. We evaluated whether metastasectomy has any survival benefit in patients with metastatic sarcomatoid dedifferentiation treated with radical nephrectomy. MATERIALS AND METHODS: From an institutional database of 273 patients with sarcomatoid dedifferentiation treated with nephrectomy we matched 80 with synchronous and asynchronous metastases for age, ECOG (Eastern Cooperative Oncology Group) performance status, histology and lymph node status. Matched pairs were then retained only if patients who did not undergo metastasectomy were alive at metastasectomy comparable to matched surgical patients to decrease the bias of survival outcomes. Overall survival from nephrectomy was studied using univariable and multivariable proportional hazards regression. RESULTS: Median overall survival was 8.3 (95% CI 6.5-10.5) and 18.5 months (95% CI 11.5-42.9) in patients with synchronous and asynchronous metastases, respectively. Overall survival in patients who underwent metastasectomy for synchronous metastasis compared to nonsurgical patients was 8.4 and 8.0 months (p = 0.35), respectively. Similarly, overall survival in patients with asynchronous metastases treated with metastasectomy compared to the nonsurgical group was 36.2 and 13.7 months, respectively (p = 0.29). On multivariable analysis positive lymph nodes at nephrectomy were associated with an increased risk of death in the synchronous and asynchronous patient subgroups (HR 2.1, 95% CI 1.1-4.0, p = 0.03 and HR 3.3, 95% CI 1.2-9.2, p = 0.02, respectively). CONCLUSIONS: In the current study there was no clear evidence of benefit in patients with sarcomatoid dedifferentiation who underwent metastasectomy after nephrectomy. Particularly, the group of patients with pathological lymph node positive disease at nephrectomy had considerably worse survival.
PURPOSE: Management of metastatic renal cell carcinoma with sarcomatoid dedifferentiation remains a therapeutic challenge with no standard treatment strategies. We evaluated whether metastasectomy has any survival benefit in patients with metastatic sarcomatoid dedifferentiation treated with radical nephrectomy. MATERIALS AND METHODS: From an institutional database of 273 patients with sarcomatoid dedifferentiation treated with nephrectomy we matched 80 with synchronous and asynchronous metastases for age, ECOG (Eastern Cooperative Oncology Group) performance status, histology and lymph node status. Matched pairs were then retained only if patients who did not undergo metastasectomy were alive at metastasectomy comparable to matched surgical patients to decrease the bias of survival outcomes. Overall survival from nephrectomy was studied using univariable and multivariable proportional hazards regression. RESULTS: Median overall survival was 8.3 (95% CI 6.5-10.5) and 18.5 months (95% CI 11.5-42.9) in patients with synchronous and asynchronous metastases, respectively. Overall survival in patients who underwent metastasectomy for synchronous metastasis compared to nonsurgical patients was 8.4 and 8.0 months (p = 0.35), respectively. Similarly, overall survival in patients with asynchronous metastases treated with metastasectomy compared to the nonsurgical group was 36.2 and 13.7 months, respectively (p = 0.29). On multivariable analysis positive lymph nodes at nephrectomy were associated with an increased risk of death in the synchronous and asynchronous patient subgroups (HR 2.1, 95% CI 1.1-4.0, p = 0.03 and HR 3.3, 95% CI 1.2-9.2, p = 0.02, respectively). CONCLUSIONS: In the current study there was no clear evidence of benefit in patients with sarcomatoid dedifferentiation who underwent metastasectomy after nephrectomy. Particularly, the group of patients with pathological lymph node positive disease at nephrectomy had considerably worse survival.
Authors: Brian Shuch; Jonathan Said; Jeff C La Rochelle; Ying Zhou; Gang Li; Tobias Klatte; Fairooz F Kabbinaavar; Allan J Pantuck; Arie S Belldegrun Journal: J Urol Date: 2009-09-16 Impact factor: 7.450
Authors: Badar M Mian; Nishin Bhadkamkar; Joel W Slaton; Peter W T Pisters; Danai Daliani; David A Swanson; Louis L Pisters Journal: J Urol Date: 2002-01 Impact factor: 7.450
Authors: Saeed Dabestani; Lorenzo Marconi; Fabian Hofmann; Fiona Stewart; Thomas B L Lam; Steven E Canfield; Michael Staehler; Thomas Powles; Börje Ljungberg; Axel Bex Journal: Lancet Oncol Date: 2014-10-26 Impact factor: 41.316
Authors: Jose A Karam; Brian I Rini; Leticia Varella; Jorge A Garcia; Robert Dreicer; Toni K Choueiri; Eric Jonasch; Surena F Matin; Steven C Campbell; Christopher G Wood; Nizar M Tannir Journal: J Urol Date: 2010-12-17 Impact factor: 7.450
Authors: Cedric Lebacle; Aydin Pooli; Thomas Bessede; Jacques Irani; Allan J Pantuck; Alexandra Drakaki Journal: World J Urol Date: 2018-06-01 Impact factor: 4.226
Authors: Andrew W Silagy; Roy Mano; Kyle A Blum; Renzo G DiNatale; Julian Marcon; Satish K Tickoo; Eduard Reznik; Jonathan A Coleman; Paul Russo; A Ari Hakimi Journal: Urology Date: 2019-11-11 Impact factor: 2.649
Authors: Brian M Shinder; Kevin Rhee; Douglas Farrell; Nicholas J Farber; Mark N Stein; Thomas L Jang; Eric A Singer Journal: Front Oncol Date: 2017-05-31 Impact factor: 6.244
Authors: Jose A Karam; A Ari Hakimi; Kyle A Blum; Sounak Gupta; Satish K Tickoo; Timothy A Chan; Paul Russo; Robert J Motzer Journal: Nat Rev Urol Date: 2020-10-13 Impact factor: 14.432