Racial/ethnic minority groups have a disproportionate burden of kidney cancer. The objective of this study was to assess if race/ethnicity was associated with a longer surgical wait time (SWT) and upstaging in the pre-COVID-19 pandemic time with a special focus on Hispanic Americans (HAs) and American Indian/Alaska Natives (AIs/ANs). Medical records of renal cell carcinoma (RCC) patients who underwent nephrectomy between 2010 and 2020 were retrospectively reviewed (n = 489). Patients with a prior cancer diagnosis were excluded. SWT was defined as the date of diagnostic imaging examination to date of nephrectomy. Out of a total of 363 patients included, 34.2% were HAs and 8.3% were AIs/ANs. While 49.2% of HA patients experienced a longer SWT (≥90 days), 36.1% of Non-Hispanic White (NHW) patients experienced a longer SWT. Longer SWT had no statistically significant impact on tumor characteristics. Patients with public insurance coverage had increased odds of longer SWT (OR 2.89, 95% CI: 1.53–5.45). Public insurance coverage represented 66.1% HA and 70.0% AIs/ANs compared to 56.7% in NHWs. Compared to NHWs, HAs had higher odds for longer SWT in patients with early-stage RCC (OR, 2.38; 95% CI: 1.25–4.53). HAs (OR 2.24, 95% CI: 1.07–4.66) and AIs/ANs (OR 3.79, 95% CI: 1.32–10.88) had greater odds of upstaging compared to NHWs. While a delay in surgical care for early-stage RCC is safe in a general population, it may negatively impact high-risk populations, such as HAs who have a prolonged SWT or choose active surveillance.

Hyponatremia was found to be a major poor prognostic marker indicating decreased survival in conjunction with its association with both poor liver and renal function profile.

Background: Hispanic Americans (HAs) and American Indians (AIs) in Arizona experience marked disparities in renal cell carcinoma (RCC) with a younger age at diagnosis, higher stage, and higher mortality rates compared to non-Hispanic Whites (NHWs). The underlying factors causing the disparities are still under investigation. This study explored relationships between neighborhood characteristics, race/ethnicity, and obesity in RCC patients. Methods: Medical records of patients who underwent RCC surgical treatment between 2010 and 2021 at Banner University Medical Center Tucson/University of Arizona were reviewed. Social Deprivation Index (SDI) score was calculated using American Community Survey data and linked to the zip code of patient’s residence. Logistic regression analysis was performed to assess associations of SDI, race/ethnicity, and BMI with RCC characteristics and perioperative outcomes. Results: A total of 379 patients (49.9% NHWs, 34.6% HAs, and 7.4% AIs) with SDI data were included in this study. They lived in 116 zip code areas (86 in NHWs, 49 in HAs, and 13 in AIs). 18 patients (4.7%) lived in the most common zip code area. 51.7% of zip codes had only one patient living in the area. HAs and AIs were more likely to have an earlier age of diagnosis and higher BMI and live in high SDI neighborhoods compared to NHWs. SDI were positively associated with BMI in the total dataset and HAs, but not in NHWs. HA ethnicity and high BMI were significantly associated with earlier age of diagnosis. HAs had increased odds of having clear cell RCC, but the association was not significant after adjusting for SDI. HAs had an increased odds of clear cell RCC only in patients living in high SDI neighborhoods (OR 3.33, 95% CI 1.00-11.07). In patients living in low SDI neighborhoods, HAs had increased odds of advanced stage (OR 2.52, 95% CI 1.17-5.45), but not in patients living high SDI neighborhoods (P-interaction=0.02). BMI≥35 was associated with advanced stage in NHWs (OR 3.08, 95% CI 1.14-8.35), but not in HAs (P-interaction=0.07). SDI was not associated with advanced stage. SDI was associated with high grade in NHWs (OR 3.08, 95% CI 1.14-8.35), but not in HAs (P-interaction=0.06). Next, we investigated impacts of obesity on perioperative outcomes adjusting for SDI. BMI≥35 was associated with a longer ischemia time (OR 3.41, 95% CI 1.06-11.2), and this association was stronger in patients living in low SDI than high SDI neighborhoods and in HAs than NHWs. HAs with BMI 30-35 had increased odds (OR 7.83, 954% CI 1.18-51.81) of a greater estimated blood loss during the surgery. Patients with BMI 25-30 had significantly increased odds (OR 6.95 95% CI 1.18-41.00) of longer hospital stay after surgery. A stronger association was observed in NHWs, and the association was not significant in HAs. Conclusion: This study revealed that SDI is an underlying factor of obesity in RCC patients. The relationships between SDI, race/ethnicity, and obesity are complex, and obesity is impacting racial/ethnic groups differently. Citation Format: Ken Batai, Waheed Asif, Patrick Wightman, Alejandro Cruz, Celina I. Valencia, Francine C. Gachupin, Chiu-Hsieh Hsu, Juan Chipollini, Benjamin R. Lee. Intersectionality of neighborhood socioeconomic deprivation, race/ethnicity, and obesity in renal cell carcinoma disparities in Hispanics and American Indians in Arizona [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr C085.

INTRODUCTION AND OBJECTIVE: Clinical T1a renal masses ( 4 cm) be managed by partial nephrectomy (PN), tumor ablation (TA), or with active surveillance (AS) for lesions under 3 cm. Safety net hospitals (SNH) may face constraints that impact the choice of treatment strategy. We examined trends in management of cT1a renal masses by SNH status using the National Cancer Database (NCDB). We hypothesized that patients treated at SNH would be more likely to undergo AS.METHODS: The NCDB was queried from 2010-2016 for adult patients with clinical T1aN0M0 renal mass. We excluded patients with multiple cancer diagnoses, and lacking treatment data (AS, TA, PN, or radical nephrectomy). SNH status has been previously defined as a hospital with >30% of patients are Medicaid-funded or uninsured. Demographic and hospital characteristics were compared by SNH status. A multivariate logistic regression model was constructed to determine odds of undergoing AS by SNH status. Kaplan Meier analysis and Cox hazards models evaluated association between overall mortality and SNH status.RESULTS: 59,861 patients met inclusion criteria. Of these, SNH only accounted for 1.8% (n [ 1,051) of reported cases. Patients with cT1a renal masses at SNH were younger [mean(SD) 55 ( 12) vs 60 (13), p<0.01], non-white (41% vs 17%), from the lowest income quartile (32% vs 13%, p<0.01), and treated in the South (56% vs 38%, p<0.01). There was no difference in Charlson comorbidity index (CCI), gender, or treatment year between groups. On multivariate analysis, SNH status predicted increased odds of undergoing AS compared to non-safety net hospitals (OR: 2.2, p<0.01). Black patients (OR: 1.6, p<0.01), non-private insurance (OR: 1.3, p<0.01), and greater CCI scores (OR: 1.2, p<0.01) predicted greater odds of AS. Highest income quartile (OR: 0.8, p<0.01) predicted higher rates of intervention. There was no difference in survival by SNH status.CONCLUSIONS: While current guidelines recommend PN, TA, or AS for cT1a renal masses, our study suggests that hospital resources may influence the treatment strategy. Patients at safety net hospitals were more likely to undergo AS despite being younger, and having no difference in comorbidity compared to patients at non-safety net hospitals. White patients, those with private insurance, and patients in the highest income quartile were more likely to receive procedural intervention. Future studies should focus on both patient and hospital factors, including limited operating room and surgeon availability, that could impact treatment decisions.