Importance of local data on occurrence and outcomes of renal cell cancer

Abstract

Background: In comparatively socioeconomically deprived areas male cancer mortality is often above the national average. Given this, we explored the pattern of presentation and outcomes of men with conventional clear cell renal cell carcinoma (CCRCC) undergoing nephrectomy at a North East of England regional tertiary referral centre. Patients and methods: A retrospective review of CCRCC patients treated with nephrectomy between 2004 and 2008 was performed. Risk of progression for men and women was calculated using Mayo, Memorial Sloan-Kettering (MSK) and Kattan prognostic scores. Outcomes of disease free progression and overall survival were measured. Results: 292 patients with complete local follow up were identified that had undergone radical nephrectomy for conventional clear cell histology. The median (range) follow up was 36 months (10–65 months), and men accounted for 64% of these cases. At presentation, 45% of cases presented with stage III–IV (>T2, N0/1, M0/1) disease compared with 32% nationally (BAUS cancer registry). At diagnosis men had more advanced tumours compared with women (54% vs. 22% for stage >T2, N0/1, M0/1; p < 0.001) and had higher risk of progression based on prognostic scores ( p < 0.01) despite similar risk factors and clinical symptoms. Early outcome analysis comparing men to women revealed both lower disease-free survival (82% vs. 89%) and overall survival (87% vs. 93%) in men at 24 months ( p < 0.01). However, stage for stage comparisons between men and women demonstrated no significant difference in survival. Discussion: Men in the North East of England presented later with more advanced CCRCC. The reason for this remained undefined in this study. This pattern is consistent with reports of adverse male cancer-related outcomes in deprived areas and highlights the importance of local data in planning local health care.