Clinical Study Of 14 Cases With Sarcomatoid Renal Cell Carcinoma And Literature Review

Objective: To investigate the clinicopathological features,prognostic factors and treatment of sarcomatoid renal cell carcinoma..Methods: 15 patients were diagnosed as sarcomatoid renal cell carcinoma in Fujian Union Hospital from 2002 to 2016.We collect patient's clinicopathologic features from medical records to assess their symptoms,diagnosis,imaging findings,treatment and prognostic factors and research progress.Clinical data were absent in 1 case,and 14 patients entered the final study.The average age of 14 patients was 54.2 years,the average diameter of the tumor was 7.7cm,the symptoms of these cases include lumbar abdominal pain(8 cases),hematuria(2cases),fever(1cases),and physical examination(2cases),cough,chest pain(1 cases).14 patients were treated with surgery,including cytoreductive nephrectomy(4 cases),laparoscopic radical nephrectomy(5 cases),open radical nephrectomy(3 cases),simple nephrectomy(2 cases).6 patients received postoperative systemic treatment,including sunitinib,IFN-? and IL-2.Results: 7 cases were pure sarcomatoid carcinoma,7 cases were renal clear cell carcinoma with sarcomatoid differentiation.Immunohistochemically,sarcomatoid renal cell carcinoma expression CK(86% 13/14),vimentin(100% 14/14),The number of cases with TNM stage: stage II(3cases),stage III(7cases),IV(4cases).Six patients underwent postoperative adjuvant therapy,5 cases were treated with sunitinib and 1case received IFN-? and IL-2.The median survival time was 6 months,and the median survival time was 8 months for patients who received postoperative adjuvant therapy.The median survival time was 3 months for those who did not receive postoperative adjuvant therapy.The median survival time with non-metastasis was 10 months and the median survival time with metastasis was 4 months,Conclusion: Sarcomatoid renal cell carcmoma has the characteristics of large tumor size,heterogeneity and infiltration growth.The clinical manifestation is obvious,and it is difficult to distinguish with the renal cell carcinoma from imaging.Therefore,it is more vigilant for renal cell carcinoma with large tumor size,heterogeneity and larger peritumoral vessels,the final diagnosis depended on pathology and immunohistochemistry.Surgery is still the preferred treatment,those who have sarcomatoid differentiation,vascular invasion and advanced cases should be given postoperative adjuvant therapy.For the postoperative patients,there should be more stringent monitoring program,timely detection of tumor progression,adjustment of treatment programs.