大多数sRCC研究集中在晚期或转移性疾病上，有限的研究分析了局部非转移性病人的结局。本研究评估了局部sRCC和4级RCC（非sRCC）病人的肾脏切除术后结局和癌症特异性生存（CSS）的预测因素。在1988年6月至2019年3月期间，共564例局部RCC患者接受了部分或根治性肾脏切除术，其中有204例sRCC和360例WHO/ISUP 4级非sRCC。比较了两组间各个阶段的CSS。使用III期ASSURE临床试验数据进行CSS结果的外部验证。采用曼-惠特尼U检验、卡方检验比较结果，并采用Kaplan-Meier方法评估CSS、总生存和无复发生存。采用Cox比例风险回归评估与RCC死亡相关的临床病理特征。中位随访时间为31.5个月。sRCC和4级非sRCC两组的中位总生存和CSS分别为45个月和102个月，49个月和152个月，p<0.001。在每个阶段，sRCC的CSS较4级非sRCC更差。值得注意的是，pT1期的sRCC的CSS比pT3级的4级非sRCC更差。CSS的负面预测因素包括肉瘤样特点、非透明细胞组织学、阳性切缘、较高阶段（pT3/pT4）和最小侵袭性手术（MIS）的使用。ASSURE外部验证显示sRCC患者的CSS较差（HR 1.63（95% CI [1.12-2.36]），p=0.01），但MIS手术并没有导致更差的结果（HR 1.39（95% CI [0.75-2.56]），p=0.30）。局部sRCC与4级非sRCC相比，在每个阶段的CSS较差。生存的负面预测因素包括阳性切缘、更高的病理分期、MIS的使用和非ccRCC组织学。sRCC是一种侵袭性变异，即使在低阶段也需要密切监测，并可能纳入辅助治疗试验中。本文章受版权保护，保留所有权利。

Most sRCC research focuses on advanced or metastatic disease, with limited studies analyzing localized non-metastatic patient outcomes. This study evaluates post-nephrectomy outcomes and predictors of cancer-specific survival (CSS) between localized sRCC and grade-4 RCC (non-sRCC) patients.564 localized RCC patients underwent partial or radical nephrectomy between June 1988 to March 2019 for sRCC (n=204) or WHO/ISUP grade-4 non-sRCC (n=360). CSS at every stage between groups were assessed. Phase-III ASSURE clinical trial data was used to externally validate CSS findings. Man-Whitney U, Chi-squared tests compared outcomes and Kaplan-Meier method evaluated CSS, overall survival (OS) and recurrence-free survival. Clinicopathologic features associated with RCC death were evaluated using Cox-proportional hazards regression.Median follow-up was 31.5 months. Median OS and CSS between 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 sRCC patients (HR 1.63 (95% 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).Localized sRCC has 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-ccRCC histology. sRCC is an aggressive variant even at low stages requiring vigilant surveillance and possible inclusion in adjuvant therapy trials.This article is protected by copyright. All rights reserved.