Renal cell carcinoma complicated with sarcomatoid differentiation: Treatment, prognosis and literature review
10.3724/SP.J.1008.2011.01016
- Author:
Hai-bo SHENG
1
Author Information
1. Department of Urology
- Publication Type:Journal Article
- Keywords:
Kidney neoplasms;
Renal cell carcinoma;
Sarcomatoid differentiation;
Therapy
- From:
Academic Journal of Second Military Medical University
2011;32(9):1016-1018
- CountryChina
- Language:Chinese
-
Abstract:
To retrospectively analyze the clinical data of 16 patients with renal cell carcinoma complicated with sarcomatoid differentiation, so as to discuss the treatment and prognosis of the condition. Methods A total of 547 patients with renal cell carcinoma were admitted in our department during 2005-2009, and 16(2.9%) of them also had sarcomatoid differentiation, including 7 males and 9 females, aged (52±10) years old, ranging 36-70 years old. Gross hematuria was found in 5 patients, backache in 5, fatigue and weight loss in 2, cough and hemoptysis in 1; and 3 patients were accidentally found with renal occupation during physical examination. All tumors were solitary, with 7 in the left and 9 in right. The maximum tumor diameter was (7.8±4.1) cm, ranging 2-15 cm. Full examination was done to confirm the tumor stage preoperatively. Preoperative examination showed that 2 patients had retroperitoneal lymph node enlargement, 1 had right pulmonary hila lymphatic metastasis, 1 had livermetastasis, 2 had renal vein and (or) the inferior vena cava tumor thrombi, 3 had bone metastases, 1 had invasion of ipsilateral adrenal gland, and 1 had invasion of the upper ureter. All the 16 patients underwent surgical treatment, and their specimens were subjected to H-E staining and immunohistochemical examination. Five patients were treated with INF-α after operation and were followed up. Results All patients received radical nephrectomy. Pathological examination showed that 9 patients had clear cell renal cell carcinoma with sarcomatoid differentiation, 3 had chromophobe renal cell carcinoma with sarcomatoid differentiation, and the other 4 had unclassified renal cell carcinoma with sarcomatoid differentiation. No recurrence or metastasis was seen in the 4 pT1N0M0 patients. All the pT2-T4 patients died, with the progression-free survival time being (5.6±4.5) months, ranging 2-16 months; the overall survival time was (8.3± 5.6) months, ranging 3-20 months. Conclusion Preoperation staging of patients with renal cell carcinoma complicated with sarcomatoid differentiation has a great impact on patient survival. Operation is the most effective treatment for patients with early stage, and routine follow-up examination is recommended postoperatively. Targeted therapy may be an effective way for patients of advanced stage.
