Race/Ethnicity Determines Life Expectancy in Surgically Treated T1aN0M0 Renal Cell Carcinoma Patients - Beyond the Abstract

The consideration of life expectancy (LE) in clinical decision-making for the treatment of oncological diseases is essential. LE estimations are even more important in settings, where the disease is considered to show low aggressiveness and low cancer-specific mortality. For our analyses, we, therefore, focused on T1aN0M0 renal cell cancer (RCC) patients, where curative management options such as radical nephrectomy (RN) or partial nephrectomy (PN) were performed.



Since Social Security Administration (SSA) life tables represent the basis for LE estimation in North American patients, we relied on SSA life tables derived data, from which we created a simulated surrogate cohort that resembles a cross-section of the survival rates of the general North American population. Using this simulated comparison cohort, we addressed overall survival rates in RN or PN treated T1aN0M0 RCC patients from the Surveillance, Epidemiology, and End Results database.

We performed our analyses in two patient cohorts: first, a historical cohort (treated between 2004 and 2006), with ten years of follow up and a second, a contemporary cohort (treated between 2009 and 2011), with five years of follow-up. Our analyses in two different year-cohorts, therefore, accounted for the known increase in PN rates over time.

The primary aim of our study was to differentiate the survival rates according to race/ethnicity. Regardless of years of treatment, African-American patients, and especially females, exhibited a significantly worse overall survival and by far fell below the estimated LE from SSA life tables, while Caucasians, Hispanic/Latinos, and Asians more or less followed LE predictions. However, encouragingly, the difference between observed overall survival and SSA life tables LE predictions for African-Americans was smaller in the more contemporary cohort. Despite this improvement, a significant disadvantage compared to other races/ethnicities still persisted. In further survival analyses, we displayed disadvantages for both cancer-specific mortality and other-cause mortality, which were especially more pronounced in African-American females than males.

In our work, we discuss potential underlying reasons for this disadvantage and refer to a literature review by Sims et al,1 where, presumably it is being hypothesized that these survival differences might be connected to the known disadvantages in comorbidity profiles and general health and lifestyle problems, that would mostly derive from environmental and occupational issues, which put African-Americans in a more disadvantageous position. Within our work, we urgently plead for corrective measures in this regard and address the insufficient workup of this disadvantage by health politics and politics in general. 

Written by: Christoph Würnschimmel, MD, University Hospital Hamburg-Eppendorf, Martini-Klinik (Germany) and the Cancer Prognostics and Health Outcomes Unit, University of Montréal Health Center, Canada

  1. Sims J, Yedjou C, Abugri D, Payton M, Turner T, Miele L, et al. Racial Disparities and Preventive Measures to Renal Cell Carcinoma. Int J Environ Res Public Health 2018;15:1089. https://doi.org/10.3390/ijerph15061089.

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