Background: Cytoreductive nephrectomy in the setting of treatment of advanced renal cell carcinoma with sarcomatoid features (sRCC) has been highly contested in terms of added benefit for survival. Patients with sRCC are known to have a poor prognosis and more aggressive tumor biology.

Methods: Pts with clear cell RCC and non-clear cell RCC underwent cytoreductive nephrectomy in efforts to improve overall survival. Patients were stratified by presence or absence of histologic presence of sarcomatoid features within the tumor samples.

Results: Of 167 patients who underwent cytoreductive nephrectomy, 127 had clear cell, of which 14 had sarcomatoid features and 40 had non-clear cell RCC of which 13 had sarcomatoid features. Median age in the cohort was 62 (range, 56.5-69). The cohort included 119 male (71.3%) and 48 (28.7%) female patients. There were 121 patients with >T3 disease, 24 (14.4%) with T2a/b disease, and 22 (13.2%) with T1a/b disease. In all patients with advanced RCC having sRCC had a significant impact on survival post-cytoreductive nephrectomy (30 vs. 8 mos; HR 2.88; p <0.0001). Additionally, good-risk patients had significantly longer OS compared to intermediate- or poor-risk patients (56 vs 30 vs 10 mos; HR 0.21; p = 0.00016). For patients with clear cell RCC, having sRCC present conferred a poorer significant survival (30 vs 9 mos; HR 2.82; p = 0.0035). Patients with non-clear cell sRCC also had significantly worse outcomes compared to those without sarcomatoid features (30 vs 6.5 mos; HR 3; p = 0.009). When sRCC patients were stratified by whether there was >10% or ≤10% present within the sample, there was no significant difference in overall survival (8 vs 8.5; p = 0.32).

Conclusions: Sarcomatoid features within tumor histology confers significantly poor prognosis. Patients with sRCC regardless of clear cell vs non-clear cell histology have significantly shorter overall survival. Even among patients with 10% or less sarcomatoid features there was no overall survival benefit to cytoreductive nephrectomy. Based on our findings, there appears to be a limited to no role of cytoreductive nephrectomy, if sRCC is identified on pre-treatment biopsy.

Citation Format: Jacob J. Adashek, Alyssa Bilotta, Jad Chahoud, Jiannong Li, Philippe E. Spiess. Outcomes of advanced renal cell carcinoma with sarcomatoid features post-cytoreductive nephrectomy in clear cell and non-clear cell disease [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 6473.