AUA 2018: Factors Driving Worse Survival Between Black and White Patients with Renal Cell Carcinoma

San Francisco, CA ( Many studies in multiple different malignancies have demonstrated a significant racial disparity between Caucasian (white) Americans and African-American (black) patients. This manifests sometimes as worse pathology and worse initial presentation, but in many cases, even accounting for the same initial presentation and pathology, outcomes are often worse in black patients. However, the underlying reasons for this disparity are not clear. This has often been attributed to lack of access to healthcare, relationship with the healthcare system, healthcare professionals acceptance of black patients, and socioeconomic differences. 

In this study, the authors attempt to highlight some of the factors driving survival differences between black and white patients with renal cell carcinoma (RCC). To do so, they utilized the National Cancer Database – a popular database that captures cancer management in the United States; however, as we have previously noted on prior coverage, it is limited to Overall Survival (OS), as cancer-specific survival (CSS) outcomes are not available!

They identified 70,422 white patients and 8,747 black patients diagnosed with RCC during the time frame specified. As is typical of many of these databases, capture of black patients is underwhelming – and likely not an accurate representation of the black population treated for cancer!

When comparing demographics, black patients presented at a younger age (60.2 vs 62.5 years, p< 0.001), with a lower stage (12.0% vs. 18.8% Stage III-IV p<0.001) and a higher rate of papillary RCC (42.8% vs.15.2%, p<0.001). However, at the same time, black patients presented with a higher Charlson-score (p<0.001), lower income (p<0.001), lower level of education (p<0.001), experienced a longer delay from diagnosis to treatment (1.13 vs. 0.92 months; p<0.001) and were less likely to receive a cytoreductive radical nephrectomy (p<0.001). 

Knowing that CSS was not available in this database, they looked at OS. Overall survival (OS) was better for black patients in the unadjusted model (HR=0.94, p=0.015), similar in the socio-demographic model (HR=0.96; p=0.087), but worse in the presentation model (HR=1.13; p<0.001) and in the treatment model (HR=1.09; p=0.001). Therefore, it would seem that, accounting for SES, black patients do as well as white patients. However, accounting for presentation and treatment, they still do worse than white patients. 

This is consistent with prior studies in other malignancies that socioeconomic factors, not race, is the driving factor in outcomes. However, it should be noted once more, that this is OS – not CSS! CSS would be more useful in this setting.

Presented by: Harry Anastos, MD
Co-Author: David Paulucci, Alp Tuna Beksac, Nikhil Waingankar, New York, NY, Hiren Patel, Stony Brook, NY, Greg Gin, Long Beach, CA, John Sfakianos, Ketan Badani, New York, NY

Written by: Thenappan Chandrasekar, MD, Clinical Fellow, University of Toronto, @tchandra_uromd at the 2018 AUA Annual Meeting - May 18 - 21, 2018 – San Francisco, CA USA