title: Clinical outcome in patients receiving systemic therapy for metastatic sarcomatoid renal cell carcinoma: a retrospective analysis.
abstract: OBJECTIVE
  Sarcomatoid metastatic renal cell carcinoma (mRCC) represents an aggressive subset of disease, and a definitive therapeutic strategy is lacking. We seek to define outcomes associated with systemic therapy (including immunotherapy, cytotoxic therapy, and targeted agents) for sarcomatoid mRCC, with attention to novel prognostic schema.
  
  
  METHODS
  From an institutional database including 270 patients with mRCC, we identified 34 patients with documented sarcomatoid features. Within this cohort, we assessed 21 patients who received systemic therapy. Survival was assessed in the overall cohort and in subgroups divided by clinicopathologic characteristics, including the extent of sarcomatoid features, Memorial Sloan-Kettering Cancer Center (MSKCC) risk criteria, Heng criteria, and the nature of systemic therapy rendered.
  
  
  RESULTS
  Of the 21 patients assessed, 2 patients received chemotherapy, 7 patients received immunotherapy, and 12 patients received targeted agents as their first line treatment. Median overall survival (OS) in the overall cohort was 18.0 months (95% CI 6.9-22.0). By MSKCC criteria, patients with poor-risk disease had a median OS of 4.7 months, compared with 20.1 months for patients with intermediate-risk disease [hazard ratio (HR) 0.02, 95%CI 0.003-0.15; P = 0.0001]. A similar difference in median OS was seen poor- and intermediate-risk groups when stratifying by Heng criteria (HR 0.17, 95%CI 0.001-0.12). There was no significant difference in survival in patients with sarcomatoid predominant disease vs. nonpredominant disease (HR 0.62, 95%CI 0.23-1.65; P = 0.34), nor was there a difference amongst patients who received targeted therapies vs. nontargeted therapies (HR 1.0, 95%CI 0.61-1.40; P = 0.36).
  
  
  CONCLUSIONS
  Compared with previous series and prospective trials assessing patients with sarcomatoid mRCC, the observed survival was prolonged. Although both Heng and MSKCC risk scores may be useful in determining prognosis, further studies are needed to identify relevant biomarkers and define the optimal therapeutic strategy for this disease.
authors.affiliation: Department of Medical Oncology and Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA. Electronic address: spal@coh.org.
authors.forename: Sumanta K
authors.initials: SK
authors.lastname: Pal
authors.forename: Jeremy O
authors.initials: JO
authors.lastname: Jones
authors.forename: Courtney
authors.initials: C
authors.lastname: Carmichael
authors.forename: Junmi
authors.initials: J
authors.lastname: Saikia
authors.forename: Joanne
authors.initials: J
authors.lastname: Hsu
authors.forename: Xueli
authors.initials: X
authors.lastname: Liu
authors.forename: Robert A
authors.initials: RA
authors.lastname: Figlin
authors.forename: Przemyslaw
authors.initials: P
authors.lastname: Twardowski
authors.forename: Clayton
authors.initials: C
authors.lastname: Lau
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000556:secondary / Q000628:therapy*; D004358:Drug Therapy; D005260:Female; D006801:Humans; D007167:Immunotherapy; D007680:Kidney Neoplasms / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D058990:Molecular Targeted Therapy; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome