Sarcomatoid renal cell carcinoma: MRI features and their association with survival

Objective To evaluate MRI features of sarcomatoid renal cell carcinoma (RCC) and their association with survival. Methods This retrospective single-center study included 59 patients with sarcomatoid RCC who underwent MRI before nephrectomy during July 2003–December 2019. Three radiologists reviewed MRI findings of tumor size, non-enhancing areas, lymphadenopathy, and volume (and percentage) of T2 low signal intensity areas (T2LIA). Clinicopathological factors of age, gender, ethnicity, baseline metastatic status, pathological details (subtype and extent of sarcomatoid differentiation), treatment type, and follow-up were extracted. Survival was estimated using Kaplan-Meier method and Cox proportional-hazards regression model was used to identify factors associated with survival. Results Forty-one males and eighteen females (median age 62 years; interquartile range 51–68) were included. T2LIAs were present in 43 (72.9%) patients. At univariate analysis, clinicopathological factors associated with shorter survival were: greater tumor size (> 10 cm; HR [hazard ratio] = 2.44, 95% CI 1.15–5.21; p = 0.02), metastatic lymph nodes (present; HR = 2.10, 95% CI 1.01–4.37; p = 0.04), extent of sarcomatoid differentiation (non-focal; HR = 3.30, 95% CI 1.55–7.01; p < 0.01), subtypes other than clear cell, papillary, or chromophobe (HR = 3.25, 95% CI 1.28–8.20; p = 0.01), and metastasis at baseline (HR = 5.04, 95% CI 2.40–10.59; p < 0.01). MRI features associated with shorter survival were: lymphadenopathy (HR = 2.24, 95% CI 1.16–4.71; p = 0.01) and volume of T2LIA (> 3.2 mL, HR = 4.22, 95% CI 1.92–9.29); p < 0.01). At multivariate analysis, metastatic disease (HR = 6.89, 95% CI 2.79–16.97; p < 0.01), other subtypes (HR = 9.50, 95% CI 2.81–32.13; p < 0.01), and greater volume of T2LIA (HR = 2.51, 95% CI 1.04–6.05; p = 0.04) remained independently associated with worse survival. Conclusion T2LIAs were present in approximately two thirds of sarcomatoid RCCs. Volume of T2LIA along with clinicopathological factors were associated with survival.