Racial disparity in renal cell carcinoma patient survival according to demographic and clinical characteristics. Cancer

Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland. .
Cancer (Impact Factor: 4.89). 08/2013; 119(2). DOI: 10.1002/cncr.27690
Source: PubMed


Patients with renal cell carcinoma (RCC) who are black tend to have poorer prognosis than similar patients who are white. This study examined whether the racial disparity in RCC patient survival varies by demographic and clinical characteristics.

Nearly 40,000 patients (4359 black and 34,991 white) diagnosed with invasive RCC from 1992 to 2007 were identified from 12 registries in the National Cancer Institute Surveillance, Epidemiology, and End Results program, covering approximately 14% of the US population. Relative survival rates through 2008 were computed using the actuarial method.

Proportionally more blacks than whites were diagnosed with RCC under age 50 and with localized cancer. Overall, the 5-year relative survival rates were 72.6% (95% confidence interval 72.0%-73.2%) for white and 68.0% (66.2%-69.8%) for black patients. Survival was higher among women than men and among younger than older patients. Survival decreased with advancing tumor stage and, within each stage, decreased with increasing tumor size. Patients with clear cell RCC, a more common form among whites, had poorer prognosis than patients with papillary or chromophobe subtypes, which are more common among blacks. Survival for patients who received no surgical treatment (10.5% of white patients and 14.5% of black patients) was substantially lower than for patients treated with nephrectomy, with similar survival among whites and blacks. In all other demographic and clinical subgroups of patients, whites consistently had a survival advantage over blacks.

Patients with RCC who are white consistently have a survival advantage over those RCC patients who are black, regardless of age, sex, tumor stage or size, histological subtype, or surgical treatment.

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    • "28. and Chow et al. 29. using Surveillance, Epidemiology, and End Results (SEER) Program data reported that both incidence and mortality rates were significantly higher in blacks. "
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    ABSTRACT: In the United States, renal cell carcinoma (RCC) has rapidly increased in incidence for over two decades. The most common histologic subtypes of RCC, clear cell, papillary, and chromophobe have distinct genetic and clinical characteristics; however, epidemiologic features of these subtypes have not been well characterized, particularly regarding any associations between race, disease subtypes, and recent incidence trends. Using data from the Surveillance, Epidemiology, and End Results (SEER) Program, we examined differences in the age-adjusted incidence rates and trends of RCC subtypes, including analysis focusing on racial differences. Incidence rates increased over time (2001–2009) for all three subtypes. However, the proportion of white cases with clear cell histology was higher than among blacks (50% vs. 31%, respectively), whereas black cases were more likely than white cases to have papillary RCC (23% vs. 9%, respectively). Moreover, papillary RCC incidence increased more rapidly for blacks than whites (P < 0.01) over this period. We also observed that increased incidence of papillary histology among blacks is not limited to the smallest size strata. We observed racial differences in proportionate incidence of RCC subtypes, which appear to be increasing over time; this novel finding motivates further etiologic, clinical, molecular, and genetic studies. Using national data, we observed a higher proportion of black renal cell carcinoma (RCC) cases with papillary histology compared to Caucasian cases. We also observed time trends in black-white incidence differences in histologic RCC subtypes, with rapid increases in the disproportionate share of black cases with papillary histology.
    Cancer Medicine 08/2013; 2(5):744-749. DOI:10.1002/cam4.110 · 2.50 Impact Factor
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    • "In particular, Gray et al. demonstrate that these vulnerable patient populations have a greater risk of not receiving aggressive therapy for an aggressive malignancy: bladder cancer [1]. This study, along with others, continues the description of disparities in cancerspecific survival in disadvantaged groups spanning the urologic malignancies, as well as other cancers [2] [3] [4]. This work is instrumental in an understanding of the multiple influences on the health outcomes of our patients and the magnitude of worse outcomes among disadvantaged groups, including elderly patients. "

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