A Gap in Disease-Specific Survival Between Younger and Older Adults With De Novo Metastatic Renal Cell Carcinoma: Results of a SEER Database Analysis

Abstract

Through an analysis of the Surveillance, Epidemiology, and End Results (SEER) registry, we demonstrate that disease-specific survival (DSS) appears to be inferior in older adults with metastatic renal cell carcinoma (mRCC) compared with younger adults. We further suggest that although DSS has improved for younger patients during the era of targeted therapies, a similar improvement is not seen among older adults. Background Consistent with other data sets, our own institutional series suggests that survival in patients aged ≥ 75 years with metastatic renal cell carcinoma (mRCC) is inferior to that in patients < 75 years. We sought to confirm these trends through exploration of the Surveillance, Epidemiology and End Results (SEER) registry. Patients and Methods We assessed disease-specific survival (DSS) in 6204 patients with clear cell, papillary, or chromophobe mRCC diagnosed between 1992 and 2009, with the a priori hypothesis that DSS was shorter in patients aged ≥ 75 years. Analyses were further stratified by the period of diagnosis, either between 1992 and 2004 (the “cytokine era”) or 2005 to 2009 (the “targeted therapy” era). Univariate and multivariate analyses were conducted to determine the association between clinicopathologic characteristics and DSS. Results DSS was shorter in patients aged ≥ 75 years than in patients aged < 75 years (9 vs. 16 months; P < .0001). In patients 18 to 74 years, DSS was superior in the targeted therapy era compared with the cytokine era (P < .0001). However, in patients ≥ 75 years, no difference in DSS was noted between these periods (P = .90). On multivariate analysis, age ≥ 75 years, female sex, diagnosis during the cytokine era, node-positive disease, and absence of cytoreductive nephrectomy were independently associated with DSS. Conclusion DSS appears to be inferior in older adults with mRCC (specifically, patients aged ≥ 75 years). Furthermore, in contrast to their younger counterparts, no improvement in DSS was seen in older adults in the transition from the cytokine era to the targeted therapy era.

Development and validation of a nomogram for predicting the impact of tumor size on cancer-specific survival of locally advanced renal cell carcinoma: a SEER-based study

“…When performing a multivariate analysis, large tumor (>120 mm) and older age (>75 years old) were confirmed to be risk factors. These findings align with the earlier outcomes reported by Nelson et al [ 26 ]. In contrast, a meta-analysis examining the predictability of benign kidney tumor revealed that age did not emerge as a standalone predictor [ 27 ].…”

Efficacy and safety of sunitinib in elderly patients with metastatic renal cell carcinoma

“…A similar trend was reported for elderly patients (⩾70 years) receiving sorafenib ( Eisen et al , 2008 ), raising the possibility that elderly patients with RCC may be more responsive to anti-angiogenic therapy; although, in our analysis, IFN- α -treated elderly patients also seemed to benefit more than younger ones from treatment (median PFS 7.9 vs 5.0 months). These studies, however, contradict a recently reported retrospective analysis of the Surveillance, Epidemiology, and End Results (SEER) registry in which disease-specific survival was inferior in older adults (⩾75 years) with metastatic RCC ( Nelson et al , 2013 ); also, in contrast to younger patients, older patients in the SEER analysis did not experience an improvement in survival in the ‘targeted therapy era' (2005–2009) relative to the ‘cytokine era' (1992–2004). Of note, however, this analysis did not report comorbidity data that may have confounded the results; only patients with de novo metastatic disease and thus inherently intermediate- or poor-risk disease were included.…”

Genetic and Chromosomal Aberrations and Their Clinical Significance in Renal Neoplasms

“…The current FDA approved targeted therapy drugs for RCC which are the tyrosine kinase inhibitors (sunitinib, sorafenib, pazopanib, and axitinib), monoclonal antibody to VEGF (bevacizumab), and the mTOR inhibitors (temsirolimus and everolimus) [ 45 ]. Targeted therapy has improved treatment outcome as the overall and cancer specific survival of metastatic RCC patients has improved in the targeted therapy era compared to the immunotherapy era [ 46 , 47 ].…”