title: Histologic evaluation of metastases in renal cell carcinoma with sarcomatoid transformation and its implications for systemic therapy.
abstract: BACKGROUND
  Sarcomatoid features in renal cell carcinoma may represent an aggressive subclone arising from the primary tumor. The patterns of metastases for these tumors were evaluated to determine if sarcomatoid features were retained at metastasis and whether the percentage of sarcomatoid features in the primary tumor influenced spread.
  
  
  METHODS
  All patients with sarcomatoid features found at nephrectomy with synchronous or metachronous resection of metastases were evaluated. The histology, grade, and percentage of sarcomatoid features in the primary and metastatic site were recorded. The association between percentage of sarcomatoid features, grade, histology, and pattern of metastases was evaluated.
  
  
  RESULTS
  Thirty-two patients were identified with sarcomatoid features and resected metastases. Fifty-two metastatic sites were evaluated. A single histologic appearance (sarcomatoid or carcinomatoid) was present in 50 of 52 sites (96%). Thirty sites (58%) demonstrated only a sarcomatoid pattern, whereas 20 (38%) contained only a carcinoma pattern. Histology and carcinoma grade did not influence metastatic pattern; however, greater percentage of sarcomatoid features was associated with the presence of distant sarcomatoid histology. A cutoff of 30% sarcomatoid features in the primary tumor was useful in predicting systemic sarcomatoid histology.
  
  
  CONCLUSIONS
  Sarcomatoid elements are frequently observed in the metastases of primary tumors with sarcomatoid features, and these metastases generally contain a solitary pattern supporting the subclone hypothesis. However, both components can metastasize in the same patient. The percentage of sarcomatoid features influences the pattern of spread, and patients with >30% sarcomatoid features in the primary tumor frequently have distant sarcomatoid histology. This cutpoint may be helpful for inclusion criteria for future clinical trials.
authors.affiliation: Department of Urology, David Geffen School of Medicine at University of California-Los Angles, Los Angeles, California 90095-1738, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Shuch
authors.forename: Jonathan
authors.initials: J
authors.lastname: Said
authors.forename: Jeffrey C
authors.initials: JC
authors.lastname: LaRochelle
authors.forename: Ying
authors.initials: Y
authors.lastname: Zhou
authors.forename: Gang
authors.initials: G
authors.lastname: Li
authors.forename: Tobias
authors.initials: T
authors.lastname: Klatte
authors.forename: Frederic
authors.initials: F
authors.lastname: Pouliot
authors.forename: Fairooz F
authors.initials: FF
authors.lastname: Kabbinavar
authors.forename: Arie S
authors.initials: AS
authors.lastname: Belldegrun
authors.forename: Allan J
authors.initials: AJ
authors.lastname: Pantuck
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000473:pathology*; D002999:Clone Cells; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D009362:Neoplasm Metastasis / Q000473:pathology*; D012509:Sarcoma / Q000473:pathology*