Clinical Study Of41Chinese Patients With Sarcomatoid Renal Cell Carcinoma

Objective:To investigate the clinical manifestation, pathological characteristics, prognosis and treatment of sarcomatoid renal cell carcinoma.Methods:41cases(31male and10female) were confirmed to be pure SRCC or SRCC composite of recognized types pathologically during3/2007to10/2013at the first affiliated hospital of Zhejiang University, median age was61years(range from34to83years).the symptoms of these cases include waist ache(19cases), hematuria(10cases), emaciation(4cases), fever(4cases), urinary tract irritation(3cases), dysuria(2cases), and physical examination(9cases), abdominal mass(5cases), percussion tenderness over kidney region(4cases) and no obvious physical finding(32cases). All cases underwent b-ultrasound, and some patients also underwent CT(33cases), MR(14cases). The average size of tumor was7.0x4.6cm(range from2.5x1.5cm to18.0x14.0cm). radical nephrectomy was performed for38cases, nephron sparing surgery was undertaken for2cases, and the last case only underwent puncture biopsy.15cases were given Immunotherapy after the operation,8cases were given targeted therapy. Results:22cases were clear cell RCC with SRCC,9cases were pure SRCC,6cases were renal pelvic carcinoma with SRCC,2cases were collecting duct carcinoma with SRCC, and2cases were squamous cell carcinoma with SRCC. The number of cases with TNM stage Ⅰ, Ⅱ,Ⅲ, Ⅳ were10,11,15,5.25cases underwent immunohistochemistry, all of them show CK(+) and vimentin(+).39cases were tracked,28of them died, the median survival time was14.7months(range from1to61months). For subgroup:TNM I-II group was18.1months, TNM Ⅲ-Ⅳ group was10.6months, Immunotherapy group was18.0months, targeted therapy group was16.2group, and pure SRCC group was11.5months.Conclusion:Sarcomatoid renal cell carcinoma is a rare and higher-degree malignant tumor. It’s hard to distinguish SRCC from nomal RCC, the final diagnosis depended on pathology and immunohistochemistry. radical nephrectomy is the main treatment. The prognosis has positive correlation with pathology type and TNM staging. Immunotherapy, chemotherapy and targeted therapy may prolong patients’survival time.