Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy; Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada.
Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany.
Urol Oncol. 2022 Nov;40(11):493.e9-493.e16. doi: 10.1016/j.urolonc.2022.06.022. Epub 2022 Jul 27.
We tested for other-cause mortality (OCM) differences according to race/ethnicity in metastatic renal cell carcinoma (mRCC). Such differences may affect treatment considerations.
Within the Surveillance, Epidemiology, and End Results Research Plus repository (2000-2018), we identified clear cell (ccmRCC) and non-clear cell (non-ccmRCC) mRCC patients and stratified according to race/ethnicity: Caucasian vs. Hispanic vs. African American vs. Asian. Poisson smoothed cumulative incidence plots and competing risks regression (CRR) models addressing OCM, after adjustment for cancer-specific mortality , were fitted. Subsequently, multivariable logistic regression models tested access to cytoreductive nephrectomy (CNT) and systemic therapy (ST).
Of 10,958 ccmRCC patients, 7,892 (72%), 1,743 (16%), 688 (6%), and 635 (6%) were Caucasian, Hispanic, African American, and Asian, respectively. Of 1,239 non-ccmRCC patients, 799 (64%), 106 (9%), 278 (22%), and 56 (5%) were Caucasian, Hispanic, African American, and Asian, respectively. In multivariable CRR models, OCM was higher in African Americans vs. Caucasians in ccmRCC (HR:1.55; CI:1.19-2.01; P < 0.001) and in non-ccmRCC (HR:1.54; CI:1.01-2.35; P = 0.04). In multivariable logistic regression models, African Americans with ccmRCC were less likely to undergo CNT (OR:0.72, CI:0.60-0.86; P < 0.001), but more likely to undergo ST (OR:1.34, CI:1.11-1.61; P = 0.002).
In this retrospective analysis, African Americans with ccmRCC and non-ccmRCC exhibited higher OCM than Caucasians. Based on higher OCM, African Americans were less likely to undergo CNT, but more likely to benefit from ST.
我们根据种族/民族测试转移性肾细胞癌（mRCC）的其他原因死亡率（OCM）差异。这些差异可能会影响治疗的考虑因素。
在监测、流行病学和最终结果研究加库（2000-2018 年）中，我们确定了透明细胞（ccmRCC）和非透明细胞（非 ccmRCC）mRCC 患者，并根据种族/民族进行分层：白种人、西班牙裔、非裔美国人、亚裔。在调整癌症特异性死亡率后，拟合泊松平滑累积发生率图和竞争风险回归（CRR）模型，以解决 OCM 问题。随后，多变量逻辑回归模型测试了接受细胞减少性肾切除术（CNT）和系统治疗（ST）的机会。
在 10958 例 ccmRCC 患者中，分别有 7892 例（72%）、1743 例（16%）、688 例（6%）和 635 例（6%）为白种人、西班牙裔、非裔美国人和亚裔。在 1239 例非 ccmRCC 患者中，分别有 799 例（64%）、106 例（9%）、278 例（22%）和 56 例（5%）为白种人、西班牙裔、非裔美国人和亚裔。在多变量 CRR 模型中，ccmRCC 中非裔美国人的 OCM 高于白种人（HR：1.55；95%CI：1.19-2.01；P<0.001），而非 ccmRCC 中非裔美国人的 OCM 也高于白种人（HR：1.54；95%CI：1.01-2.35；P=0.04）。在多变量逻辑回归模型中，ccmRCC 中非裔美国人接受 CNT 的可能性较小（OR：0.72，95%CI：0.60-0.86；P<0.001），但接受 ST 的可能性较大（OR：1.34，95%CI：1.11-1.61；P=0.002）。
在这项回顾性分析中，ccmRCC 和非 ccmRCC 的非裔美国人的 OCM 高于白种人。基于较高的 OCM，非裔美国人接受 CNT 的可能性较小，但更有可能受益于 ST。
