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Cancer-Specific Mortality in Sarcomatoid Renal Cell Carcinoma: A Histological Subtype-Controlled Analysis

Michele Nicolazzini1,2,3, Calogero Catanzaro1,4, Federico Polverino1,5

  • 1Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC H2X 0A9, Canada.

Journal of Clinical Medicine
|March 28, 2026
PubMed

Insights

Sarcomatoid dedifferentiation significantly increases cancer-specific mortality in both clear cell (ccRCC) and non-clear cell renal cell carcinoma (nccRCC). This aggressive feature has a more pronounced detrimental effect on survival in nccRCC compared to ccRCC.

Area of Science:

  • Urology
  • Oncology
  • Pathology

Background:

  • Sarcomatoid dedifferentiation is a recognized feature in renal cell carcinoma (RCC).
  • Its impact on cancer-specific mortality (CSM) requires detailed investigation in both clear cell (ccRCC) and non-clear cell (nccRCC) subtypes.
  • Understanding this association is crucial for prognostic assessment and treatment strategies.

Purpose of the Study:

  • To evaluate the effect of sarcomatoid dedifferentiation on cancer-specific mortality (CSM) in ccRCC.
  • To assess the impact of sarcomatoid dedifferentiation on CSM in nccRCC.
  • To compare the prognostic significance of sarcomatoid dedifferentiation between ccRCC and nccRCC.

Main Methods:

  • Utilized the SEER database (2010-2021) for patient data.
  • Employed propensity score matching (PSM) to create comparable cohorts.
  • Conducted multivariable competing risks regression (CRR) to analyze CSM.

Main Results:

  • Sarcomatoid dedifferentiation was identified in 3.0% of ccRCC and 1.9% of nccRCC cases.
  • In ccRCC, sarcomatoid dedifferentiation independently predicted a 1.6-fold higher CSM (HR 1.6, p < 0.001).
  • In nccRCC, sarcomatoid dedifferentiation independently predicted a 2.0-fold higher CSM (HR 2.0, p < 0.001), indicating a greater impact.

Conclusions:

  • Sarcomatoid dedifferentiation is consistently linked to increased CSM in both ccRCC and nccRCC.
  • The adverse prognostic impact of sarcomatoid dedifferentiation is more significant in nccRCC than in ccRCC.
  • These findings highlight the importance of recognizing sarcomatoid dedifferentiation for improved patient stratification and management.
Keywords:
SEER databasehistological subtyperenal cancersarcomatoidsurvival

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