Outcome and prognosis of metastatic sarcomatoid renal cell carcinoma (sRCC) in the targeted therapy era are not well described. In this retrospective series of 230 patients with metastatic sRCC, we examined the role of anti–vascular endothelial growth factor (VEGF) agents as a treatment option. The validity of the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) prognostic model in patients with metastatic sRCC was confirmed. Sarcomatoid histology was found to be an independent factor for adverse prognosis.