Other-cause mortality and access to care in metastatic renal cell carcinoma according to race/ethnicity

BACKGROUND: We tested for other-cause mortality (OCM) differences according to race/ethnicity in metastatic renal cell carcinoma (mRCC). Such differences may affect treatment considerations.

METHODS: Within the Surveillance, Epidemiology, and End Results Research Plus repository (2000-2018), we identified clear cell (ccmRCC) and non-clear cell (non-ccmRCC) mRCC patients and stratified according to race/ethnicity: Caucasian vs. Hispanic vs. African American vs. Asian. Poisson smoothed cumulative incidence plots and competing risks regression (CRR) models addressing OCM, after adjustment for cancer-specific mortality , were fitted. Subsequently, multivariable logistic regression models tested access to cytoreductive nephrectomy (CNT) and systemic therapy (ST).

RESULTS: Of 10,958 ccmRCC patients, 7,892 (72%), 1,743 (16%), 688 (6%), and 635 (6%) were Caucasian, Hispanic, African American, and Asian, respectively. Of 1,239 non-ccmRCC patients, 799 (64%), 106 (9%), 278 (22%), and 56 (5%) were Caucasian, Hispanic, African American, and Asian, respectively. In multivariable CRR models, OCM was higher in African Americans vs. Caucasians in ccmRCC (HR:1.55; CI:1.19-2.01; P < 0.001) and in non-ccmRCC (HR:1.54; CI:1.01-2.35; P = 0.04). In multivariable logistic regression models, African Americans with ccmRCC were less likely to undergo CNT (OR:0.72, CI:0.60-0.86; P < 0.001), but more likely to undergo ST (OR:1.34, CI:1.11-1.61; P = 0.002).

CONCLUSIONS: In this retrospective analysis, African Americans with ccmRCC and non-ccmRCC exhibited higher OCM than Caucasians. Based on higher OCM, African Americans were less likely to undergo CNT, but more likely to benefit from ST.