Introduction

The treatment of patient with metastatic renal cell carcinoma (mRCC) has evolved significantly over the past decade. Access to newer systemic agents and cytoreductive nephrectomy (CN) may differ according to sociodemographic factors. We sought to evaluate racial disparities in the treatment of mRCC and if there is any difference in survival according to race.

Methods

We used the National Cancer Data Base (NCDB) to identify patients with mRCC at diagnosis between 1998 and 2012. Study period was dichotomized: the immunotherapy era (1998-2005) and the TT era (2006-2012). Race was categorized as non-Hispanic White (NHW), African American (AA), Hispanics and others. Multivariable logistic regression analyses predicting the receipt of CN, systemic therapy (ST) and metastatecomy (MTSX) adjusted for measured confounders were performed. Kaplan-Meier and Cox regression analyses were used to evaluate the difference in overall survival (OS) between races adjusting for patient and system characteristics.

Results

During the study period, we identified 50,764 patients with mRCC, of which 41,995 (83%), 5,238 (10%), 3,246 (6%) and 285 (1%) were NHW, AA, Hispanic or other race, respectively. NHW patients were more often older (p<0.001), had less comorbidities (p<0.001), were more often covered by private insurance (p<0.001) and less often treated in an academic center (p<0.001). On multivariable regression, compared to NHW, all races had lower odds of receiving CN (Odds Ratio [OR]= 0.54, 0.77, 0.45 for AA, Hispanics or other, respectively, all p<0.01). AA and Hispanic patients were less likely to receive MTSX (OR=0.65 and 0.80, p<0.001 and 0.04, respectively) and the gap was accentuated in the TT era. AA and Hispanics were less likely to receive ST (OR=0.72 and 0.82, respectively, both p<0.01). In adjusted OS analysis, AA had significantly worse OS compared to NHW (Hazard Ratio [HR]=1.25 95%CI 1.15-1.36, p<0.001).

Conclusions

Racial disparities in receipt of care for patients with mRCC exist and these differences are more pronounced in the TT era. These inequalities may explain why AA patients have worse survival than their NHW counterparts._x000D_

Funding

none