Disparities in survival outcomes in African Americans in renal cell carcinoma: Impact of oncological versus nononcological factors.

Authors

null

Margaret Frances Meagher

University of California San Diego, San Diego, CA

Margaret Frances Meagher , Aaron Bradshaw , David Anyakora , Dattatraya H Patil , Kazutaka Saito , Brittney Cotta , Yosuke Yasuda , Ahmed Eldefrawy , Stephen Ryan , Ryan Nasseri , Juliana Alksne , Fang Wan , Yasuhisa Fujii , Viraj A. Master , Ithaar Derweesh

Organizations

University of California San Diego, San Diego, CA, Emory University, Atlanta, GA, Tokyo Medical and Dental University, Tokyo, Japan, Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan, Winship Cancer Institute of Emory University, Atlanta, GA

Research Funding

NIH

Background: African-Americans have increased incidences of renal cortical tumor subtypes of lower oncological potential in the setting of lower risk disease when compared to other ethno-racial groups. However, survival outcomes are similar. We investigated the impact of African-American race on overall survival, oncological outcomes, functional outcomes, and non-cancer mortality. Methods: Multi-institutional retrospective analysis of patients who underwent partial or radical nephrectomy between 1998-2018. Primary outcome was overall survival (OS). Secondary outcomes included non-cancer mortality (NCM), recurrence free survival (RFS), and estimated glomerular filtration rate (eGFR) decline. Multivariable logistic regression (MVA) were used to elucidate predictive factors for OS, NCM, and RFS, and eGFR <45 and <30 ml/min/1.73m2. Results: 3,088 patients were divided into African American (AA, n=353) and Non-African American (NAA, n=2735) sub-groups. No difference was noted between groups with respect to mean tumor size (p=0.211) or metastases presence (p=0.846). African-American race was an independent risk factor for functional decline to eGFR<45 (OR 4.43, p<0.001) and eGFR<30 (OR 5.15, p<0.001). MVA for worsened NCM demonstrated African-American race (OR=1.72, p=0.042), increasing age (OR=1.03, p=0.001), radical nephrectomy (OR=2.98, p<0.001), and increasing tumor size (OR=1.26, p<0.001) to be independent risk factors. MVA for worsened OS included increasing age (OR=1.04, p<0.001), tumor size (OR=1.182, p<0.001), clear cell histology (OR=1.62, p<0.001), high tumor grade (OR=2.12, p<0.001), and post-operative eGFR <45 (OR=2.12, p<0.001). MVA for worsening RFS demonstrated high tumor grade (OR=2.38, p<0.001) and increasing clinical tumor size (OR=1.152, p<0.001) to be independent factors. Conclusions: African Americans undergoing renal surgery for RCC appear to have similar OS and RFS, but poorer NCM than non-African American patients. The cause of these disparities is multi-faceted and likely associated with functional decline. Nephron-sparing management should be considered in African-Americans presenting with renal cortical tumors.

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Abstract Details

Meeting

2019 Genitourinary Cancers Symposium

Session Type

Poster Session

Session Title

Poster Session C: Renal Cell Cancer

Track

Renal Cell Cancer

Sub Track

Renal Cell Cancer

Citation

J Clin Oncol 37, 2019 (suppl 7S; abstr 595)

DOI

10.1200/JCO.2019.37.7_suppl.595

Abstract #

595

Poster Bd #

F12

Abstract Disclosures

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