title: Impact of Rhabdoid Differentiation on Prognosis for Patients with Grade 4 Renal Cell Carcinoma.
abstract: Renal cell carcinoma (RCC) with rhabdoid differentiation is thought to portend a poor prognosis, similar to RCC with sarcomatoid differentiation. Both features are currently classified as grade 4 RCC based on the most recent International Society of Urological Pathology (ISUP) grading system. We reviewed a large series of patients with grade 4 RCC to determine the differential effects of rhabdoid and sarcomatoid differentiation on patient outcome. We identified 406 patients with ISUP grade 4 RCC including 111 (27%) with rhabdoid differentiation. In multivariable analysis of grade 4 RCC tumors, the presence of rhabdoid differentiation was not associated with death from RCC (hazard ratio [HR]: 0.95; p=0.75); in contrast, sarcomatoid differentiation was significantly associated with death from RCC (HR: 1.63; p<0.001). Patients with RCC with rhabdoid differentiation were significantly more likely to die of RCC than a comparison cohort of 1758 patients with grade 3 RCC (HR: 2.45; p<0.001). The novel findings of our study suggest that rhabdoid and sarcomatoid differentiation should not be grouped together when assessing risk in a patient with grade 4 RCC but support the notion that rhabdoid differentiation is appropriately placed in the ISUP grade 4 category.
authors: Department of Oncology, Mayo Clinic, Rochester, MN, USA.
authors: Ben Y
authors: BY
authors: Zhang
authors: Department of Pathology, Mayo Clinic, Rochester, MN, USA.
authors: John C
authors: JC
authors: Cheville
authors: Department of Urology, Mayo Clinic, Rochester, MN, USA.
authors: R Houston
authors: RH
authors: Thompson
authors: Division of Biomedical Informatics and Statistics, Mayo Clinic, Rochester, MN, USA.
authors: Christine M
authors: CM
authors: Lohse
authors: Department of Urology, Mayo Clinic, Rochester, MN, USA.
authors: Stephen A
authors: SA
authors: Boorjian
authors: Department of Urology, Mayo Clinic, Rochester, MN, USA.
authors: Bradley C
authors: BC
authors: Leibovich
authors: Department of Oncology, Mayo Clinic, Rochester, MN, USA. Electronic address: Costello.brian@mayo.edu.
authors: Brian A
authors: BA
authors: Costello
mesh_terms: D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000473:pathology*; D002454:Cell Differentiation; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D060787:Neoplasm Grading; D011379:Prognosis; D016016:Proportional Hazards Models; D012042:Registries; D018570:Risk Assessment
keywords: Prognosis; Renal cell carcinoma; Rhabdoid differentiation; Sarcomatoid differentiation; Survival