Epidemiological trends in renal cell carcinoma (RCC) in the cytokine (CYT) and targeted therapy (TT) eras: A registry analysis of 28,252 patients (pts).

Abstract

4598 Background: Randomized trials of TT have shown significant improvement in RCC pt outcomes, leading to the approval of 6 new agents since 2004. It is uncertain whether this improvement is confined to highly selected pt cohorts in clinical trials or if this benefit has already translated to the broader RCC population. To explore this, we analyzed a large RCC pt registry for epidemiologic trends, comparing the CYT (1998-2003) and TT (2004-2007) eras. Methods: Data from the California Cancer Registry (CCR), a population-based cancer surveillance system, were used. We retrospectively analyzed 28,252 RCC pts diagnosed between ’98-’07. Inter-era differences in clinical variables including year of diagnosis, histology, age, sex, race, stage, nephrectomy (Nx) status, overall (OS) and cause-specific (CSS) survival were assessed. Results: RCC frequency increased from 7.55% to 12.46%. SEER stage at diagnosis was localized in 64.42%, regional in 17.25%, and distant in 16.5%. Nx rate for pts with distant stage was 44%. Non-clear cell histologies increased (10.97% to 19.73%, p<0.001). Inter-era comparisons are shown in the Table. Conclusions: In this initial analysis of a large RCC registry, OS and CSS have not appreciably increased in the TT versus CYT era. These preliminary results suggest that the OS benefit from TT has not yet translated into the general RCC pt population. However, longer follow-up for pts in the TT era is necessary for a more robust comparison of long term OS. Multivariate OS analysis of the CCR database is ongoing. Supported by the Egan Family Fund. Variable Cytokine era (1998-2003)N = 14,956 Targeted therapy era (2004-2007)N = 13,296 Age, median in yrs 63 63 Clear cell histology (n, %) 13,316 (89.03) 10,673 (80.27) White race 9,900 (35.4) 8,209 (29.35) Stage (localized) 9,193 (61.47) 9,008 (67.75) Stage (regional) 2,732 (18.27) 2,141 (16.1) Stage (distant) 2,684 (17.95) 1,977 (14.87) Male sex 9,614 (64.28) 8,598 (64.67) Nephrectomy—yes (all pts) 12,647 (84.56) 11,389 (85.66) 3 yr survival, crude (all pts)* 68% 75% 3 yr survival (cause-specific)* 81% 81% 3 yr survival (cause-specific), clear cell histology* 77% 83% 3 yr survival (cause-specific), distant stage* 19.6% 20.5% * Estimated No significant financial relationships to disclose.