Sorce Gabriele, Hoeh Benedikt, Hohenhorst Lukas, Panunzio Andrea, Tappero Stefano, Nimer Nancy, Tian Zhe, Larcher Alessandro, Capitanio Umberto, Tilki Derya, Terrone Carlo, Chun Felix K H, Antonelli Alessandro, Saad Fred, Shariat Shahrokh F, Montorsi Francesco, Briganti Alberto, Karakiewicz Pierre I
Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada.
World J Urol. 2022 Dec;40(12):2971-2978. doi: 10.1007/s00345-022-04183-0. Epub 2022 Oct 12.
Systemic therapies (ST) improved contemporary survival rates, relative to historical in clear cell metastatic renal carcinoma (ccmRCC) patients. The magnitude of this improvement is unknown according to race/ethnicity.
Within the SEER registry (2000-2017), ccmRCC patients were stratified according to race/ethnicity (Caucasian, Hispanic, African American, Asian) and historical (2000-2009) vs contemporary (2010-2017) years of diagnosis. Competing risks regression (CRR) with adjustment for other-cause mortality and Poisson smoothed cumulative incidence plots addressed cancer-specific mortality (CSM).
Of 10,141 mRCC patients, 4316 (43%) vs 5825 (57%) were diagnosed in historical vs contemporary era. Of 4316 historical patients, 3203 (74%) vs 593 (14%) vs 293 (7%) vs 227 (5%) were Caucasian, Hispanic, African American and Asian. Of 5825 contemporary patients, 4124 (71%) vs 977 (17%) vs 362 (6%) vs 362 (6%) were Caucasian, Hispanic, African American and Asian. Between 2000 and 2017, ST rates ranged from 12 to 57% in Caucasians, 2 to 57% in Hispanics, 33 to 50% in African Americans, 17 to 70% in Asians and universally increased toward a plateau in 2010. In Caucasians, CSM decreased from 80 to 74% vs 79 to 74% in Hispanics vs 79 to 77% in African Americans, but not in Asians (67-73%). Nonetheless, these rates translated into independent predictor status of contemporary years of diagnosis in all race/ethnicity groups: CSM hazard ratios of 0.75, 0.75, 0.73 and 0.80 in, respectively, Caucasian, Hispanic, African American and Asian.
In all race/ethnicity groups, contemporary ST rates increased and improved CSM rates have also been recorded.
相对于透明细胞转移性肾细胞癌（ccmRCC）患者的历史数据，全身治疗（ST）提高了当代的生存率。但根据种族/民族，这种改善的程度尚不清楚。
在监测、流行病学和最终结果（SEER）数据库（2000 - 2017年）中，ccmRCC患者根据种族/民族（白种人、西班牙裔、非裔美国人、亚裔）以及历史诊断年份（2000 - 2009年）与当代诊断年份（2010 - 2017年）进行分层。采用竞争风险回归（CRR）并调整其他原因导致的死亡率，以及泊松平滑累积发病率图来分析癌症特异性死亡率（CSM）。
在101,41例mRCC患者中，4316例（43%）在历史时期被诊断，5825例（57%）在当代被诊断。在4316例历史时期患者中，白种人、西班牙裔、非裔美国人、亚裔分别为3203例（74%）、593例（14%）、293例（7%）、227例（5%）。在5825例当代患者中，白种人、西班牙裔、非裔美国人、亚裔分别为4124例（71%）、977例（17%）、362例（6%）、362例（6%）。2000年至2017年期间，白种人的ST使用率从12%到57%不等，西班牙裔为2%到57%，非裔美国人为33%到50%，亚裔为17%到70%，且在2010年普遍上升至平稳状态。白种人的CSM从80%降至74%，西班牙裔从79%降至74%，非裔美国人从79%降至77%，但亚裔未下降（67% - 73%）。尽管如此，这些比率在所有种族/民族群体中都转化为当代诊断年份的独立预测指标：白种人、西班牙裔、非裔美国人、亚裔的CSM风险比分别为0.75、0.75、0.73和0.80。
在所有种族/民族群体中，当代ST使用率增加，CSM率也有所改善。
