{"doi":"10.1111/bju.16125","title":"Localised non‐metastatic sarcomatoid renal cell carcinoma: a 31‐year externally verified study","abstract":"OBJECTIVE: To evaluate post-nephrectomy outcomes and predictors of cancer-specific survival (CSS) between patients with localised sarcomatoid renal cell carcinoma (sRCC) and those with Grade 4 RCC (non-sRCC), as most sRCC research focuses on advanced or metastatic disease with limited studies analysing outcomes of patients with localised non-metastatic sRCC. PATIENTS AND METHODS: A total of 564 patients with localised RCC underwent partial or radical nephrectomy between June 1988 to March 2019 for sRCC (n = 204) or World Health Organization/International Society of Urological Pathology Grade 4 non-sRCC (n = 360). The CSS at every stage between groups was assessed. Phase III ASSURE clinical trial data were used to externally validate the CSS findings. The Mann-Whitney U-test and chi-squared test compared outcomes and the Kaplan-Meier method evaluated CSS, overall survival (OS) and recurrence-free survival. Clinicopathological features associated with RCC death were evaluated using Cox proportional hazards regression. RESULTS: The median follow-up was 31.5 months. The median OS and CSS between the sRCC and Grade 4 non-sRCC groups was 45 vs 102 months and 49 vs 152 months, respectively (P < 0.001). At every stage, sRCC had worse CSS compared to Grade 4 non-sRCC. Notably, pT1 sRCC had worse CSS than pT3 Grade 4 non-sRCC. Negative predictors of CSS were sarcomatoid features, non-clear cell histology, positive margins, higher stage (pT3/pT4), and use of minimally invasive surgery (MIS). ASSURE external verification showed worse CSS in patients with sRCC (hazard ratio [HR] 1.63, 95% confidence interval [CI] 1.12-2.36; P = 0.01), but not worse outcomes in MIS surgery (HR 1.39, 95% CI 0.75-2.56; P = 0.30). CONCLUSIONS: Localised sRCC had worse CSS compared to Grade 4 non-sRCC at every stage. Negative survival predictors included positive margins, higher pathological stage, use of MIS, and non-clear cell histology. sRCC is an aggressive variant even at low stages requiring vigilant surveillance and possible inclusion in adjuvant therapy trials.","journal":"British Journal of Urology","year":2023,"id":370299,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":7,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.5292,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":348097,"name":"Andrew W. Silagy","orcid":"0000-0002-4990-8445","position":1,"is_corresponding":false},{"id":470241,"name":"Andrea Knežević","orcid":"0000-0002-0741-2150","position":2,"is_corresponding":false},{"id":616270,"name":"Stanley Weng","orcid":"0000-0002-3750-0709","position":3,"is_corresponding":false},{"id":863276,"name":"Alan Wang","orcid":"0000-0001-9749-0082","position":4,"is_corresponding":false},{"id":348096,"name":"Roy Mano","orcid":"0000-0003-3855-0211","position":5,"is_corresponding":false},{"id":348092,"name":"Julian Marcon","orcid":"0000-0001-5304-817X","position":6,"is_corresponding":false},{"id":314352,"name":"Renzo G. DiNatale","orcid":"0000-0002-7867-2881","position":7,"is_corresponding":false},{"id":348093,"name":"Alejandro Sánchez","orcid":"0000-0002-9054-7346","position":8,"is_corresponding":false},{"id":325595,"name":"Satish K. Tickoo","orcid":"0000-0002-9775-0478","position":9,"is_corresponding":false},{"id":348095,"name":"Sounak Gupta","orcid":"0000-0001-5163-6955","position":10,"is_corresponding":false},{"id":226686,"name":"Robert J. Motzer","orcid":"0000-0001-6925-2327","position":11,"is_corresponding":false},{"id":560133,"name":"Naomi B. Haas","orcid":"0000-0001-8907-7968","position":12,"is_corresponding":false},{"id":807948,"name":"Se Eun Kim","orcid":"0000-0001-6626-0786","position":13,"is_corresponding":false},{"id":337837,"name":"Robert G. Uzzo","orcid":"0000-0003-2398-6530","position":14,"is_corresponding":false},{"id":90753,"name":"Jonathan Coleman","orcid":"0000-0002-6428-7835","position":15,"is_corresponding":false},{"id":90737,"name":"A. Ari Hakimi","orcid":"0000-0002-0930-8824","position":16,"is_corresponding":false},{"id":348101,"name":"Paul Russo","orcid":"0000-0001-7487-6783","position":17,"is_corresponding":false},{"id":314354,"name":"Kyle A. Blum","orcid":"0000-0002-2484-385X","position":0,"is_corresponding":true}],"reference_count":31,"raw_metadata":null,"created_at":"2026-07-19T01:15:37.094100Z","pmid":"37589200","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}