Clinicopathologic and survival differences between African Americans and Caucasians with renal cell carcinoma.

Abstract

296 Background: The incidence of renal cell carcinoma (RCC) has gradually increased over the past decades, particularly among African Americans (AA). Lifestyle and other factors such as high blood pressure and tobacco exposure are associated with its incidence. We aim to compare differences in clinicopathologic characteristics and survival outcomes between AA and Caucasian patients undergoing nephrectomy for RCC. Methods: A retrospective single institutional analysis was performed on AA or Caucasian patients undergoing nephrectomy for RCC between 1996 and 2021. Baseline clinical and pathologic characteristics were compared by race. Survival outcomes, including cancer-specific survival (CSS) and overall survival (OS), were assessed by Kaplan-Meier methods and multivariable Cox regression analysis (MVA). Results: We included 2,439 patients (445 AA, 1987 Caucasians). AA patients were female-predominant compared to Caucasians (54.8% vs. 35.7%, p<0.01). AA patients were more likely to have a history of hypertension (44.0% vs. 40.3%, p<0.001) and diabetes (14.4% vs. 11.4%, p<0.001). Caucasian race was associated with higher pathologic stage (p<0.001), positive nodal status (3.8% vs. 1.1%, p=0.016), and metastatic disease at presentation (3.7% vs. 1.8%, p=0.042). AA had more papillary variant compared to Caucasians (36 v 15.7%, p<0.01). The 5-year CSS across all stages was better for AA vs. Caucasians (93.1% vs. 89.7%, p=0.01), but after adjusting for covariates, race was not significant for CSS on MVA (HR 0.89 (95% CI 0.57-1.38), p=0.8). Similar findings were seen in OS. We performed additional sub-analyses on patients with stage pT1a (n=665) and locally advanced (pT3-4, n=431) clear cell RCC. Among these sub-groups, no significant differences were seen by race. Conclusions: Within our institutional cohort, AA patients with RCC undergoing nephrectomy did not exhibit worse pathologic characteristics at presentation or inferior survival outcomes compared to their Caucasian counterparts. There were notable differences among baseline clinical characteristics and histology by race. Socioeconomic and molecular analyses will help elucidate biological differences and identify socially actionable strategies to improve outcomes among patients with RCC.