A gap in disease-specific survival between younger and older adults with de novo metastatic renal cell carcinoma: results of a SEER database analysis.

BACKGROUND: Consistent with other data sets, our own institutional series suggests that survival in patients aged ≥ 75 years with metastatic renal cell carcinoma (mRCC) is inferior to that in patients < 75 years. We sought to confirm these trends through exploration of the Surveillance, Epidemiology and End Results (SEER) registry. PATIENTS AND METHODS: We assessed disease-specific survival (DSS) in 6204 patients with clear cell, papillary, or chromophobe mRCC diagnosed between 1992 and 2009, with the a priori hypothesis that DSS was shorter in patients aged ≥ 75 years. Analyses were further stratified by the period of diagnosis, either between 1992 and 2004 (the "cytokine era") or 2005 to 2009 (the "targeted therapy" era). Univariate and multivariate analyses were conducted to determine the association between clinicopathologic characteristics and DSS.
RESULTS: DSS was shorter in patients aged ≥ 75 years than in patients aged < 75 years (9 vs. 16 months; P < .0001). In patients 18 to 74 years, DSS was superior in the targeted therapy era compared with the cytokine era (P < .0001). However, in patients ≥ 75 years, no difference in DSS was noted between these periods (P = .90). On multivariate analysis, age ≥ 75 years, female sex, diagnosis during the cytokine era, node-positive disease, and absence of cytoreductive nephrectomy were independently associated with DSS.
CONCLUSION: DSS appears to be inferior in older adults with mRCC (specifically, patients aged ≥ 75 years). Furthermore, in contrast to their younger counterparts, no improvement in DSS was seen in older adults in the transition from the cytokine era to the targeted therapy era.