title: Survival Outcomes and Tumor IMP3 Expression in Patients with Sarcomatoid Metastatic Renal Cell Carcinoma.
abstract: Metastatic renal cell carcinoma with sarcomatoid histology (SmRCC) is associated with poor survival. No data is available from randomized trials on the efficacy of vascular endothelial growth factor (VEGF) and mammalian target of rapamycin (mTOR) inhibitors in SmRCC. We identified SmRCC patients from a single institutional database. To identify predictive and prognostic biomarkers, immunohistochemistry (IHC) analysis was performed on the tumor samples for downstream targets of VEGF and mTOR pathways. Survival outcomes were stratified by IHC analysis, extent of sarcomatoid component, Memorial Sloan-Kettering Cancer Center (MSKCC), and Heng risk criteria. Twenty-seven patients with SmRCC were included. First line therapy included targeted therapy (n = 19), immunotherapy (n = 4), cytotoxic chemotherapy (n = 1), and no treatment (n = 3). Median OS was 8.2 months (95% CI 3.8-14.2 months). Median survival in months, based on MSKCC and Heng risk groups, was favorable 89.3 versus 84.5, intermediate 9.5 versus 12.7, and poor 3.9 versus 5.1. None of the IHC markers predicted outcomes of treatment with VEGF or mTOR inhibitors. Only tumor IMP3 expression was associated with inferior OS, although not statistically significant (IMP3 negative 14.2 versus IMP3 positive 4.9 months; HR 0.46, 95% CI 0.16-1.21; P = 0.12). The study was limited by small sample size.
authors: Department of Internal Medicine, University of Utah Huntsman Cancer Institute, Salt Lake City, UT 84112, USA.
authors: Srinivas K
authors: SK
authors: Tantravahi
authors: ARUP Laboratories, Department of Pathology, The University of Utah, Salt Lake City, UT 84108, USA.
authors: Daniel
authors: D
authors: Albertson
authors: ARUP Laboratories, Department of Pathology, The University of Utah, Salt Lake City, UT 84108, USA.
authors: Archana M
authors: AM
authors: Agarwal
authors: Department of Internal Medicine, University of Utah Huntsman Cancer Institute, Salt Lake City, UT 84112, USA.
authors: Sowmya
authors: 0000-0002-4515-3225
authors: S
authors: Ravulapati
authors: Department of Internal Medicine, University of Utah Huntsman Cancer Institute, Salt Lake City, UT 84112, USA.
authors: Austin
authors: A
authors: Poole
authors: Department of Internal Medicine, University of Utah Huntsman Cancer Institute, Salt Lake City, UT 84112, USA.
authors: Shiven B
authors: SB
authors: Patel
authors: Department of Internal Medicine, University of Utah Huntsman Cancer Institute, Salt Lake City, UT 84112, USA.
authors: Jamil S
authors: JS
authors: Hawatmeh
authors: Department of Internal Medicine, University of Utah Huntsman Cancer Institute, Salt Lake City, UT 84112, USA.
authors: Alli M
authors: AM
authors: Straubhar
authors: ARUP Laboratories, Department of Pathology, The University of Utah, Salt Lake City, UT 84108, USA.
authors: Ting
authors: T
authors: Liu
authors: Pharmacotherapy Outcomes Research Center (PORC), College of Pharmacy, The University of Utah, Salt Lake City, UT 84112, USA.
authors: David D
authors: DD
authors: Stenehjem
authors: Department of Internal Medicine, University of Utah Huntsman Cancer Institute, Salt Lake City, UT 84112, USA.
authors: Neeraj
authors: 0000-0003-1076-0428
authors: N
authors: Agarwal