Overall survival in metastatic renal cell carcinoma differs by race, gender, treatment
Among patients with metastatic renal cell carcinoma (mRCC), there are multiple factors that affect overall survival, including race, gender, treatment, and socioeconomic factors, as reported in a study.
The study used data from the National Cancer Database (2004–2015) and included 31,989 adult mRCC patients. Multivariable logistic regression models were used to evaluate factors associated with systemic therapy and cytoreductive nephrectomy utilization, while Cox proportional hazards regression models were applied to estimate overall survival.
Of the patients, 30.2 percent underwent cytoreductive nephrectomy, 51.6 percent received systemic therapy, and 25.8 percent did not undergo treatment. Compared with men, women had lower odds of receiving systemic therapy (odds ratio [OR], 0.91; p<0.01) and were more likely to remain untreated (OR, 1.14; p<0.01).
In terms of ethnicity, non-Hispanic Black and Hispanic patients had much lower odds of receiving cytoreductive nephrectomy (OR, 0.75; p<0.01 and OR, 0.86; p=0.01, respectively). On the other hand, Black patients were less likely to receive systemic therapy (OR, 0.85; p<0.01) and had higher odds of remaining untreated (OR, 1.41; p<0.01).
Further analysis revealed that Black patients were at increased risk of death (hazard ratio [HR], 1.06; p=0.03), driven by lower utilization of systemic therapy and cytoreductive nephrectomy. The differences in survival disappeared after accounting for receipt of therapy (HR, 0.99; p=0.66).
The findings underscore the importance of dismantling systemic barriers and increasing access to care for certain populations to reduce disparities and improve outcomes in mRCC.