Abstract
Renal sarcomas are a rare subgroup of soft tissue tumors that encompasses a diverse spectrum of histological subtypes each manifested by distinguishing cellular features and clinical characteristics. Management of this entity represents a challenge given the scarcity of published evidence. Utilizing National Cancer Data Base (NCDB), we aimed to explore the incidence, treatment and outcomes of kidney sarcoma.
We performed a retrospective analysis from NCDB kidney dataset which contains data on patient demographics, tumor characteristics, treatment modalities, outcomes. We obtained data from all patients with codes for renal sarcoma between 2004-2020. Multivariable logistic regression was performed to analyze prognostic factors of overall survival (OS).
1,128 patients were included in the study, 52% were males, and with a median age of 61 (50-71). The predominant histological subtypes classified were leiomyosarcoma (32.5%), liposarcoma (18.8%), and vascular sarcomas (9%). Positive lymph nodes were found on clinical staging in 207 patients (18%), and distant metastasis in 106 patients (9.4%). 77% underwent surgical intervention, with radical nephrectomy being the predominant approach (70%) followed by partial nephrectomy in 6.2%. Furthermore, 26.2% received chemotherapy, and 12.7% were treated with radiation therapy. By the time of analysis, 31% patients were still alive with median follow up of 66 months.
Multivariable analysis revealed that age, male gender, poorly differentiated tumors, nodal disease were associated with worse OS. All surgical approaches showed a statistically significant benefit in OS. The use of chemotherapy or radiation treatment in any modality was not statistically significant. Notably, the presence of positive surgical margins was associated with worse outcomes on univariable analysis but not in MVA. Of the multiple histologies, liposarcoma had better prognosis as compared to leiomyosarcoma (OR=2.3, p<0.001), vascular sarcoma (OR=3.9, p=0.03), synovial sarcoma (OR=7, p<0.01).
Renal sarcoma is a rare entity, with poor prognosis in patients with metastatic disease, undifferentiated tumors. Surgical treatment remains to be the principal prognostic approach for the management of these tumors. The role of complimentary treatment did not show benefit in overall survival