Sarcomatoid Dedifferentiation as a Predictor of Cancer-Specific Mortality in Surgically Treated Localized Renal Cell Carcinoma. Incesu, R., Morra, S., Scheipner, L., Baudo, A., Cano Garcia, C., Barletta, F., Assad, A., Tian, Z., Saad, F., Shariat, S. F., Briganti, A., Chun, F. K. H., Carmignani, L., Ahyai, S., Longo, N., Tilki, D., Graefen, M., & Karakiewicz, P. I. Annals of Surgical Oncology, 31(8):5457–5464, August, 2024.
Sarcomatoid Dedifferentiation as a Predictor of Cancer-Specific Mortality in Surgically Treated Localized Renal Cell Carcinoma [link]Paper  doi  abstract   bibtex   
Abstract Background In contemporary surgically treated patients with localized high-grade (G3 or G4) clear-cell renal cell carcinoma (ccRCC), it is not known whether presence of sarcomatoid dedifferentiation is an independent predictor and/or an effect modifier, when cancer-specific mortality (CSM) represents an endpoint. Methods Within the Surveillance, Epidemiology, and End Results database, all surgically treated localized high-grade ccRCC patients treated between 2010 and 2020 were identified. Univariable and multivariable Cox-regression models were used. Results In 18,853 surgically treated localized high-grade (G3 or G4) ccRCC patients, 5-year CSM-free survival was 87% (62% vs. 88% with vs. without sarcomatoid dedifferentiation, p  \textless 0.001). Presence of sarcomatoid dedifferentiation was an independent predictor of higher CSM (hazard ratio [HR] 1.8, p  \textless 0.001). In univariable survival analyses predicting CSM, presence versus absence of sarcomatoid dedifferentiation in G3 versus G4 yielded the following hazard ratios: HR 1.0 in absent sarcomatoid dedifferentiation in G3; HR 2.7 ( p  \textless 0.001) in absent sarcomatoid dedifferentiation in G4; HR 3.9 ( p  \textless 0.001) in present sarcomatoid dedifferentiation in G3; HR 5.1 ( p  \textless 0.001) in present sarcomatoid dedifferentiation in G4. Finally, in multivariable Cox-regression analyses, the interaction terms defining present versus absent sarcomatoid dedifferentiation in G3 versus G4 represented independent predictors of higher CSM. Conclusions In contemporary surgically treated patients with localized high-grade ccRCC, sarcomatoid dedifferentiation is not only an independent multivariable predictor of higher CSM, but also interacts with tumor grade and results in even better ability to predict CSM.
@article{incesu_sarcomatoid_2024,
	title = {Sarcomatoid {Dedifferentiation} as a {Predictor} of {Cancer}-{Specific} {Mortality} in {Surgically} {Treated} {Localized} {Renal} {Cell} {Carcinoma}},
	volume = {31},
	issn = {1068-9265, 1534-4681},
	url = {https://link.springer.com/10.1245/s10434-024-15431-5},
	doi = {10.1245/s10434-024-15431-5},
	abstract = {Abstract
            
              Background
              In contemporary surgically treated patients with localized high-grade (G3 or G4) clear-cell renal cell carcinoma (ccRCC), it is not known whether presence of sarcomatoid dedifferentiation is an independent predictor and/or an effect modifier, when cancer-specific mortality (CSM) represents an endpoint.
            
            
              Methods
              Within the Surveillance, Epidemiology, and End Results database, all surgically treated localized high-grade ccRCC patients treated between 2010 and 2020 were identified. Univariable and multivariable Cox-regression models were used.
            
            
              Results
              
                In 18,853 surgically treated localized high-grade (G3 or G4) ccRCC patients, 5-year CSM-free survival was 87\% (62\% vs. 88\% with vs. without sarcomatoid dedifferentiation,
                p 
                {\textless} 0.001). Presence of sarcomatoid dedifferentiation was an independent predictor of higher CSM (hazard ratio [HR] 1.8,
                p 
                {\textless} 0.001). In univariable survival analyses predicting CSM, presence versus absence of sarcomatoid dedifferentiation in G3 versus G4 yielded the following hazard ratios: HR 1.0 in absent sarcomatoid dedifferentiation in G3; HR 2.7 (
                p 
                {\textless} 0.001) in absent sarcomatoid dedifferentiation in G4; HR 3.9 (
                p 
                {\textless} 0.001) in present sarcomatoid dedifferentiation in G3; HR 5.1 (
                p 
                {\textless} 0.001) in present sarcomatoid dedifferentiation in G4. Finally, in multivariable Cox-regression analyses, the interaction terms defining present versus absent sarcomatoid dedifferentiation in G3 versus G4 represented independent predictors of higher CSM.
              
            
            
              Conclusions
              In contemporary surgically treated patients with localized high-grade ccRCC, sarcomatoid dedifferentiation is not only an independent multivariable predictor of higher CSM, but also interacts with tumor grade and results in even better ability to predict CSM.},
	language = {en},
	number = {8},
	urldate = {2025-01-28},
	journal = {Annals of Surgical Oncology},
	author = {Incesu, Reha-Baris and Morra, Simone and Scheipner, Lukas and Baudo, Andrea and Cano Garcia, Cristina and Barletta, Francesco and Assad, Anis and Tian, Zhe and Saad, Fred and Shariat, Shahrokh F. and Briganti, Alberto and Chun, Felix K. H. and Carmignani, Luca and Ahyai, Sascha and Longo, Nicola and Tilki, Derya and Graefen, Markus and Karakiewicz, Pierre I.},
	month = aug,
	year = {2024},
	pages = {5457--5464},
}
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