Impacts of Neighborhood Characteristics and Surgical Treatment Disparities on Overall Mortality in Stage I Renal Cell Carcinoma Patients

Abstract

Racial/ethnic minority groups in the United States have high renal cell carcinoma (RCC) mortality rates. This study assessed surgical treatment disparities across racial/ethnic groups and impacts of neighborhood socioeconomic characteristics on surgical treatments and overall mortality. Stage I RCC patients diagnosed between 2004 and 2016 from National Cancer Database were included (n = 238,141). We assessed differences in associations between race/ethnicity and treatment patterns using logistic regression and between race/ethnicity and overall mortality using Cox regression with and without neighborhood characteristics in the regression models. When compared to non-Hispanic Whites (NHWs), American Indians/Alaska Natives and non-Hispanic Blacks (NHBs) were more likely not to receive surgical care and all racial/ethnic minority groups had significantly increased odds of undergoing radical rather than partial nephrectomy, even after adjusting for neighborhood characteristics. Including surgical treatment and neighborhood factors in the models slightly attenuated the association, but NHBs had a significantly increased risk of overall mortality. NHBs who underwent radical nephrectomy had an increased risk of mortality (HR 1.15, 95% CI: 1.08–1.23), but not for NHBs who underwent partial nephrectomy (HR 0.92, 95% CI: 0.84–1.02). Neighborhood factors were associated with surgical treatment patterns and overall mortality in both NHBs and NHWs. Neighborhood socioeconomic factors may only partly explain RCC disparities.

Clear cell renal cell carcinoma molecular variations innon‐HispanicWhite and Hispanic patients

“…Our findings may not be generalizable and studies in other parts of the United States, where other Hispanic subgroups, such as Cuban and Puerto Rican are better represented, may show different patterns. We previously reported different RCC clinicopathologic, surgical treatment, and outcome patterns across Hispanic subgroups 6,9,47 . This study also explored the associations between modifiable risk factors and molecular data, but the associations were not significant, potentially due to the small sample size, small effects, or imprecise measurement/misclassification.…”

“…We previously reported different RCC clinicopathologic, surgical treatment, and outcome patterns across Hispanic subgroups. 6,9,47 This study also explored the associations between modifiable risk factors and molecular data, but the associations were not significant, potentially due to the small sample size, small effects, or imprecise measurement/misclassification. Due to the small sample size, stratified analysis for Hispanics and NHWs using Cox regression analysis to assess the associations between identified genes and overall mortality was not possible.…”

Disparities in Clinical Care and Research in Renal Cell Carcinoma

“…Although combination ICI-based therapies 265 remain the current first-line care standard for the 266 majority of patients with advanced RCC [33] hold income, and distance to resourced healthcare 309 settings, and can arise from structural racism, which refers to the multitude of ways in which societies foster racial discrimination through systems of housing, employment, education, credit, and criminal justice [40]. Not surprisingly, these factors contribute across race/ethnicity subgroups to adverse RCC clinical outcomes, including lower rates of receipt of treatment and surgical nephrectomy and inferior overall survival [41].…”