Ján Šulgan, Martin Jonáš, Roman Tomaškin, Ján Švihra, Eliáš Boris, Pavol Slávik, Ján Ľupták
Objectives: The aim of the study is a retrospective evaluation of patients with sarcomatoid variant of kidney cancer that
underwent the surgery at our institution. We focused on the disease stage at the time of diagnosis and overall survival
after surgery.
Methods: Seventy two patients were treated at our institution between 2004 and 2014. Patients underwent radical nephrectomy
(open or laparoscopic), lymphadenectomy in case of clinically positive lymphatic nodes, metastasectomy for
solitary resectable metastasis and cytoreductive nephrectomy in a small group of patients. The data for analysis were
gathered from medical records at our department. We used standard descriptive and analytical statistical methods, including
Kaplan-Meier survival analysis.
Results: In all, 72 patients with median of age 62.7 years (range 40 – 84 years) were included in the study with identical
number of men and women, i.e. 36 (50%). Average longest diameter of tumour was 9.1 cm (SD ± 3.6 cm). Fuhrman nuclear
grading was G4 in all cases (by definition?). The T stage was the following: T1 10 (13.9%), T2 2 (2.8%), T3a 28 (38.8%),
T3b 24 (33.3%) and T4 8 (11.1%). Metastatic lymph nodes were found in 14 (19.4%). Distant metastases were observed/
diagnosed in 25 (34.7%) patients. The dominating surgical technique was transperitoneal approach in 67 (93.1%) cases.
Overall survival was 76.3% in first years of follow-up, but in the second year it declined to 47.2%. Overall survival was
36.1% after 3 years and 26% after 4 years of follow-up. At the end of 5 year period only 20% of patients survived.
Conclusion: Dedifferentiated sarcomatoid cancer is biologically and clinically the most aggressive type of kidney cancer.
Currently, we do not have multicentric randomized trials dealing with its early diagnosis and treatment. Consistent
understanding of its biological behaviour, intensified monitoring of post-operative follow-up, aggressive surgical
and medical therapy are important factors contributing to improvement of the prognosis of patients with this histological
type of the tumour.