MP68-09 DISPARITIES IN SURVIVAL OUTCOMES IN AFRICAN AMERICANS IN RENAL CELL CARCINOMA

Abstract

INTRODUCTION AND OBJECTIVE: African-Americans have an increased incidence of renal cortical tumor subtypes of lower oncological potential in the setting of lower risk disease when compared to other ethno-racial groups. On the other hand, survival outcomes are similar. We investigated the impact of African-American race on functional outcomes and non-cancer mortality. METHODS: Multi-institutional (Emory, TMDU, UCSD, SLU) retrospective analysis of patients with localized renal cell carcinoma (AJCC clinical stage 1-3 RCC) who underwent partial or radical nephrectomy between 1998-2018. The cohort was divided into African-American and Non-African American subgroups for descriptive analyses. Patients were analyzed for demographics, clinical parameters, and post-surgical outcomes. Primary outcome was non-cancer mortality (NCM). Secondary outcome was eGFR decline. Multivariable logistic regression (MVA) was used to elucidate predictive factors for NCM and de novo eGFR<45 and <30 ml/min/1.73m2. Kaplan Meier Analysis (KMA) was performed to analyze 5-year freedom from non-cancer mortality. RESULTS: 3751 patients who received either partial or radical nephrectomy for renal masses were grouped into African American (AA, n=602) and Non-African American (NAA, n=3149) sub-groups for analysis. No difference was noted between groups with respect to mean tumor size (p=0.166). Risk factors for development of de novo eGFR<45 included increasing age (OR 1.059, p<0.001), AA race (OR 1.47, p=0.047, diabetes mellitus (OR 1.84, p<0.001), and radical nephrectomy (OR 3.28, p<0.001). MVA for worsened NCM demonstrated AA race (OR 1.4, p=0.013), increasing age (OR 1.05, p<0.001), and post-operative eGFR<45 (OR 2.8, p<0.001) to be independent risk factors. KMA revealed a significant difference between African-Americans and Non-African Americans in terms of 5 year NCM (AA 81% vs. NAA 88%, p<0.001). CONCLUSIONS: African Americans undergoing renal surgery for RCC appear to have poorer NCM than non-African American patients. The cause of this disparity is likely multi-faceted but may be associated with functional decline. Nephron-sparing management when feasible and appropriate should be considered in African-Americans presenting with renal cortical tumors.Source of Funding: Stephen Weissman Kidney Cancer Research Fund