Percentage of sarcomatoid histology is associated with survival in renal cell carcinoma: Stratification and implications by clinical metastatic stage

•Sarcomatoid histology (SH) in renal cell carcinoma is independently associated with overall survival and recurrence-free survival•Percentage of SH and clinical M stage were important for risk stratification in the vascular endothelial growth factor and immuno-oncology eras•Patients with cM0 and any degree of SH may be candidates for adjuvant immunotherapy•Patients with cM0 and ≥20% SH likely carry micrometastatic disease and should receive closer surveillance