Histologic evaluation of metastases in renal cell carcinoma with sarcomatoid transformation and its implications for systemic therapy.
Histologic evaluation of metastases in renal cell carcinoma with sarcomatoid transformation and its implications for systemic therapy.
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DOI：
10.1002/cncr.24768
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发表时间：
2010-02-01
期刊：
影响因子：
6.2
通讯作者：
Pantuck, Allan J.
中科院分区：
文献类型：
--
作者：
Shuch, Brian;Said, Jonathan;LaRochelle, Jeffrey C.;Zhou, Ying;Li, Gang;Klatte, Tobias;Pouliot, Frederic;Kabbinavar, Fairooz F.;Belldegrun, Arie S.;Pantuck, Allan J.
肾细胞癌的肉瘤样特征可能代表原发肿瘤产生的侵袭性亚克隆。评估这些肿瘤的转移模式，以确定肉瘤样特征是否在转移时保留，以及原发肿瘤中肉瘤样特征的百分比是否影响扩散。所有在肾切除术中发现肉瘤样特征的患者同时或异时切除转移瘤进行了评估。记录原发和转移部位肉瘤样特征的组织学、分级和百分比。评估肉瘤样特征的百分比、分级、组织学和转移模式之间的关系。32例患者被确定为肉瘤样特征和切除转移。对52个转移部位进行了评价。单一的组织学表现（肉瘤样或癌样）存在于50 52个网站（96%）。30个部位（58%）仅显示肉瘤样模式，而20个部位（38%）仅包含癌模式。组织学和肿瘤分级不影响转移模式，然而，更大比例的肉瘤样特征与远处肉瘤样组织学的存在相关。在预测系统性肉瘤样组织学时，原发肿瘤中30%肉瘤样特征的截止值是有用的。肉瘤样成分经常在具有肉瘤样特征的原发性肿瘤的转移灶中观察到，这些转移灶通常包含支持亚克隆假说的孤立模式。然而，这两种成分可以在同一患者中转移。肉瘤样特征的百分比影响扩散模式，原发肿瘤中肉瘤样特征>30%的患者通常具有远处肉瘤样组织学。该临界点可能有助于制定未来临床试验的入选标准。
Sarcomatoid features in renal cell carcinoma may represent an aggressive subclone arising from the primary tumor. The patterns of metastases for these tumors were evaluated to determine if sarcomatoid features were retained at metastasis and whether the percentage of sarcomatoid features in the primary tumor influenced spread. All patients with sarcomatoid features found at nephrectomy with synchronous or metachronous resection of metastases were evaluated. The histology, grade, and percentage of sarcomatoid features in the primary and metastatic site were recorded. The association between percentage of sarcomatoid features, grade, histology, and pattern of metastases was evaluated. Thirty-two patients were identified with sarcomatoid features and resected metastases. Fifty-two metastatic sites were evaluated. A single histologic appearance (sarcomatoid or carcinomatoid) was present in 50 of 52 sites (96%). Thirty sites (58%) demonstrated only a sarcomatoid pattern, whereas 20 (38%) contained only a carcinoma pattern. Histology and carcinoma grade did not influence metastatic pattern; however, greater percentage of sarcomatoid features was associated with the presence of distant sarcomatoid histology. A cutoff of 30% sarcomatoid features in the primary tumor was useful in predicting systemic sarcomatoid histology. Sarcomatoid elements are frequently observed in the metastases of primary tumors with sarcomatoid features, and these metastases generally contain a solitary pattern supporting the subclone hypothesis. However, both components can metastasize in the same patient. The percentage of sarcomatoid features influences the pattern of spread, and patients with >30% sarcomatoid features in the primary tumor frequently have distant sarcomatoid histology. This cutpoint may be helpful for inclusion criteria for future clinical trials.
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影响因子：
45.3
作者：
Cangiano, T;Liao, J;Belldegrun, A
通讯作者：
Belldegrun, A
影响因子：
6.6
作者：
Weisei, W;Dockerty, MB;Priestley, JI
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Priestley, JI
影响因子：
6.2
作者：
MACKE, RA;HUSSAIN, MB;COHEN, SM
通讯作者：
COHEN, SM
影响因子：
45.3
作者：
Golshayan, Ali Reza;George, Saby;Rini, Brian I.
通讯作者：
Rini, Brian I.
影响因子：
2.5
作者：
Kwak, Cheol;Park, Yong Hyun;Ku, Ja Hyeon
通讯作者：
Ku, Ja Hyeon