Arpit Rao1, Charles Wiggins2, Richard C Lauer3. 1. Division of Hematology, Oncology & Transplantation, University of Minnesota, Minnesota, MN, USA. 2. Department of Internal Medicine, New Mexico Tumor Registry, University of New Mexico, Albuquerque, NM, USA. 3. Division of Hematology and Oncology, University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA.
Abstract
BACKGROUND: Advanced renal cell carcinoma (RCC) results in over 14,000 deaths each year in the United States alone. The therapeutic landscape for advanced RCC changed dramatically with the approval of tyrosine kinase inhibitors (TKI) between 2006 and 2012. A large-scale analysis of survival trends has not been performed in the TKI era to determine their impact on outcomes for advanced RCC patients. METHODS: The Surveillance, Epidemiology and End-Results (SEER) database was queried for adult patients with advanced RCC diagnosed between 2000 and 2013. Patients were divided into two cohorts based on the year of diagnosis-pre-TKI cohort [2000-2006] and TKI cohort [2007-2013]. Kaplan-Meier survival and multivariate Cox proportional hazards analyses were performed. RESULTS: A total of 14,976 patients were included in our study. Median age at diagnosis was 64 years (range, 18-89 years). Median (cancer-specific) overall survival was 10.0 months in the TKI cohort compared with 8.0 months in the pre-TKI cohort, corresponding to a 13% improvement in survival in the TKI area [hazard ratio (HR) for death 0.87; 95% confidence interval (CI), 0.84-0.91, P<0.0001]. Median survival was improved by 2 months for patients with clear-cell RCC histology [HR for death 0.86; 95% CI, 0.84-0.91, P<0.0001]. Patients with non-clear cell RCC had a 25% higher risk of mortality compared with those with clear-cell RCC. Additionally, median survival for non-clear cell RCC patients was not statistically different between the two cohorts (HR for death 0.98; 95% CI, 0.88-1.09, P=0.714). Subgroup analysis showed that elderly patients (age 71 years and above) had a 45% higher risk of death from advanced RCC compared with young patients (aged 18-50 years) [HR for death 1.45; 95% CI, 1.36-1.54, P<0.0001]. Gender and racial disparities in outcomes were also noted with women having a 10% higher risk of death compared with men (HR for death 1.10; 95% CI, 1.06-1.14, P<0.001) and Black patients having a 15% higher risk of death compared with White patients (HR for death 1.15; 95% CI, 1.08-1.23, P<0.0001). CONCLUSIONS: Our study provides a largest registry-based analysis of survival outcomes in the TKI era. In majority of patients, the survival has improved significantly with the advent of TKIs as standard of care therapy. Survival for patients with non-clear cell RCC is clearly worse than clear-cell RCC and does not appear to have changed with TKIs. Elderly patients, women, and Black patients appear to have worse outcomes and these disparities merit further investigation.
BACKGROUND: Advanced renal cell carcinoma (RCC) results in over 14,000 deaths each year in the United States alone. The therapeutic landscape for advanced RCC changed dramatically with the approval of tyrosine kinase inhibitors (TKI) between 2006 and 2012. A large-scale analysis of survival trends has not been performed in the TKI era to determine their impact on outcomes for advanced RCC patients. METHODS: The Surveillance, Epidemiology and End-Results (SEER) database was queried for adult patients with advanced RCC diagnosed between 2000 and 2013. Patients were divided into two cohorts based on the year of diagnosis-pre-TKI cohort [2000-2006] and TKI cohort [2007-2013]. Kaplan-Meier survival and multivariate Cox proportional hazards analyses were performed. RESULTS: A total of 14,976 patients were included in our study. Median age at diagnosis was 64 years (range, 18-89 years). Median (cancer-specific) overall survival was 10.0 months in the TKI cohort compared with 8.0 months in the pre-TKI cohort, corresponding to a 13% improvement in survival in the TKI area [hazard ratio (HR) for death 0.87; 95% confidence interval (CI), 0.84-0.91, P<0.0001]. Median survival was improved by 2 months for patients with clear-cell RCC histology [HR for death 0.86; 95% CI, 0.84-0.91, P<0.0001]. Patients with non-clear cell RCC had a 25% higher risk of mortality compared with those with clear-cell RCC. Additionally, median survival for non-clear cell RCC patients was not statistically different between the two cohorts (HR for death 0.98; 95% CI, 0.88-1.09, P=0.714). Subgroup analysis showed that elderly patients (age 71 years and above) had a 45% higher risk of death from advanced RCC compared with young patients (aged 18-50 years) [HR for death 1.45; 95% CI, 1.36-1.54, P<0.0001]. Gender and racial disparities in outcomes were also noted with women having a 10% higher risk of death compared with men (HR for death 1.10; 95% CI, 1.06-1.14, P<0.001) and Black patients having a 15% higher risk of death compared with White patients (HR for death 1.15; 95% CI, 1.08-1.23, P<0.0001). CONCLUSIONS: Our study provides a largest registry-based analysis of survival outcomes in the TKI era. In majority of patients, the survival has improved significantly with the advent of TKIs as standard of care therapy. Survival for patients with non-clear cell RCC is clearly worse than clear-cell RCC and does not appear to have changed with TKIs. Elderly patients, women, and Black patients appear to have worse outcomes and these disparities merit further investigation.
Authors: Lauren C Harshman; Wanling Xie; Georg A Bjarnason; Jennifer J Knox; Mary MacKenzie; Lori Wood; Sandy Srinivas; Ulka N Vaishampayan; Min-Han Tan; Sun-Young Rha; Frede Donskov; Neeraj Agarwal; Christian Kollmannsberger; Scott North; Brian I Rini; Daniel Y C Heng; Toni K Choueiri Journal: Lancet Oncol Date: 2012-08-08 Impact factor: 41.316
Authors: Joshua E Logan; Edward N Rampersaud; Geoffrey A Sonn; Karim Chamie; Arie S Belldegrun; Allan J Pantuck; Dennis J Slamon; Fairooz F Kabbinavar Journal: Rev Urol Date: 2012
Authors: Alexander Sankin; Jacob Cohen; Hongbei Wang; Richard J Macchia; Nicholas Karanikolas Journal: Int Braz J Urol Date: 2011 Jan-Feb Impact factor: 1.541
Authors: Nathan A Berger; Panos Savvides; Siran M Koroukian; Eva F Kahana; Gary T Deimling; Julia H Rose; Karen F Bowman; Robert H Miller Journal: Trans Am Clin Climatol Assoc Date: 2006
Authors: Jie Lin; Shelia H Zahm; Craig D Shriver; Mark Purdue; Katherine A McGlynn; Kangmin Zhu Journal: Cancer Causes Control Date: 2015-05-09 Impact factor: 2.506
Authors: Yan Song; Jinwan Wang; Xiubao Ren; Jie Jin; Li Mao; Chris Liang; Lieming Ding; Lin Yang Journal: Chin J Cancer Res Date: 2021-02-28 Impact factor: 5.087
Authors: Sumanta Pal; Jun Gong; Shivani K Mhatre; Shih-Wen Lin; Andy Surinach; Sarika Ogale; Rini Vohra; Herschel Wallen; Daniel George Journal: BMC Cancer Date: 2019-06-07 Impact factor: 4.430
Authors: Hee Sang Hwang; Yun Yong Park; Su Jin Shin; Heounjeong Go; Ja Min Park; Sun Young Yoon; Jae Lyun Lee; Yong Mee Cho Journal: J Korean Med Sci Date: 2020-02-10 Impact factor: 2.153