Ethnic disparities in renal cell carcinoma: An analysis of Hispanic patients in a single‐payer healthcare system

Suarez‐Sarmiento, Alfredo; Yao, Xiaopan; Hofmann, Jonathan N.; Syed, Jamil; Zhao, Wei; Purdue, Mark P.; Chow, Wong Ho; Corley, Douglas A.; Shuch, Brian

doi:10.1111/iju.13424

Cited by 24 publications

(33 citation statements)

References 26 publications

(38 reference statements)

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“…These findings are in concordance with prior studies about RCC in HAs. 5,12 Although the analysis results should be treated with caution owing to small sample size, we also found similar characteristics in the NA patients, such as younger age of diagnosis, higher frequency of ccRCC, and higher prevalence of diabetes than EA patients. Moreover, our results suggest that race/ ethnicity and obesity are risk factors independently associated with increased odds of RCC diagnosis at a younger age (< 50 years).…”

Section: Discussionsupporting

confidence: 63%

“…4 One study also indicated that HAs appeared to be diagnosed at younger ages, have greater comorbidities, and present more frequently with clear-cell renal cell carcinoma (ccRCC) compared with EA patients. 5 Furthermore, it is well-known that in the United States, access to health care varies significantly by racial/ethnic groups, and this may explain the differences in cancer-related outcomes owing to treatment barriers. [6][7][8][9]…”

Section: Introductionmentioning

confidence: 99%

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Racial and Ethnic Disparities in Renal Cell Carcinoma: An Analysis of Clinical Characteristics

Batai

Rosa

Lwin

et al. 2019

Clinical Genitourinary Cancer

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Variations in clinical characteristics in underrepresented patients with renal cell carcinoma were investigated. This study included 294 patients and showed Hispanic and Native American patients were more likely to be diagnosed with clear-cell subtype and at a younger age than European American patients. Older Hispanic patients who spoke Spanish were more likely to have advanced stage renal cell carcinoma. Background: Racial/ethnic minority groups, including Hispanic Americans (HAs) and Native Americans (NAs), have a heavier burden of kidney cancer than European Americans (EAs). We investigated variations in clinical characteristics of HA and NA patients with renal cell carcinoma (RCC) who were previously underrepresented. Materials and Methods: Clinical records of 294 patients with RCC (151 EAs, 95 HAs, 22 NAs, and 26 others) without prior diagnosis of cancer were reviewed. Logistic regression analysis was performed to understand patients' clinical characteristics. Results: HAs had about 5 years younger average age at diagnosis than EAs (55.8 vs. 60.5 years) and an almost 3-fold increased odds of diagnosis before age 50 years (odds ratio [OR], 2.77; 95% confidence interval [CI], 1.39-5.54). The mean age of diagnosis among NAs was 49.7 years, and NAs had an over 6-fold higher odds of diagnosis at a younger age (OR, 6.23; 95% CI, 2.00-19.46). Clear-cell RCC (ccRCC) was more common in HAs and NAs than EAs. Over 90% of HA patients had ccRCC, whereas only 78.8% of EA patients had ccRCC. HAs had increased odds of diagnosis with ccRCC compared with EAs (OR, 2.79; 95% CI, 1.15-6.80). Among HAs, older patients and patients who spoke Spanish as their primary language were more likely to have advanced stage RCC at diagnosis (OR, 10.48; 95% CI, 1.69-64.89 and OR, 4.61; 95% CI, 1.38-15.40). Conclusion: HA and NA patients with RCC had different clinical characteristics than EA patients. It is necessary to better understand the clinical characteristics of these underserved HA and NA populations with high kidney cancer burden.

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Section: Discussionsupporting

confidence: 63%

Section: Introductionmentioning

confidence: 99%

Racial and Ethnic Disparities in Renal Cell Carcinoma: An Analysis of Clinical Characteristics

Batai

Rosa

Lwin

et al. 2019

Clinical Genitourinary Cancer

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“…16 A study from Texas showed that ccRCC was very common among HAs, 17 but in the study from northern California, the frequencies of ccRCC were similar between HAs and NHWs. 33 RCC histologic subtypes may have several implications in treatment and prognosis, which play a role in preoperative counseling. It has been reported that ccRCC is more likely to present with advanced T stage, metastatic disease, and higher grade, and therefore patients with ccRCC tend to have a worse prognosis than patients with other histologic subtypes of RCC.…”

Section: Discussionmentioning

confidence: 99%

Racial/ethnic disparities in renal cell carcinoma: Increased risk of early‐onset and variation in histologic subtypes

et al. 2019

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Background Racial/ethnic minority groups have a higher burden of renal cell carcinoma (RCC), but RCC among Hispanic Americans (HAs) and American Indians and Alaska Natives (AIs/ANs) are clinically not well characterized. We explored variations in age at diagnosis and frequencies of RCC histologic subtypes across racial/ethnic groups and Hispanic subgroups using National Cancer Database (NCDB) and Arizona Cancer Registry Data. Methods Adult RCC cases with known race/ethnicity were included. Logistic regression analysis was performed to estimate odds and 95% confidence interval (CI) of early‐onset (age at diagnosis <50 years) and diagnosis with clear cell RCC (ccRCC) or papillary RCC. Results A total of 405 073 RCC cases from NCDB and 9751 cases from ACR were identified and included. In both datasets, patients from racial/ethnic minority groups had a younger age at diagnosis than non‐Hispanic White (NHW) patients. In the NCDB, AIs/ANs had twofold increased odds (OR, 2.21; 95% CI, 1.88‐2.59) of early‐onset RCC compared with NHWs. HAs also had twofold increased odds of early‐onset RCC (OR, 2.14; 95% CI, 1.79‐2.55) in the ACR. In NCDB, ccRCC was more prevalent in AIs (86.3%) and Mexican Americans (83.5%) than NHWs (72.5%). AIs/ANs had twofold increased odds of diagnosis with ccRCC (OR, 2.18; 95% CI, 1.85‐2.58) in the NCDB, but the association was stronger in the ACR (OR, 2.83; 95% CI, 2.08‐3.85). Similarly, Mexican Americans had significantly increased odds of diagnosis with ccRCC (OR, 2.00; 95% CI, 1.78‐2.23) in the NCDB. Conclusions This study reports younger age at diagnosis and higher frequencies of ccRCC histologic subtype in AIs/ANs and Hispanic subgroups. These variations across racial/ethnic groups and Hispanic subgroups may have potential clinical implications.

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“…These seven variables have been proposed in earlier models for the prediction of postoperative recurrence risk of patients diagnosed with RCCC [21] 23, and are also consistent with the main prognostic factors of CCRC. The difference of race has also been shown to be strongly predictive of evaluation risk after radical nephrectomy [22], but according to AIC analysis, the model including race exhibited weaker performance.…”

Section: Discussionmentioning

confidence: 99%

Development of a novel nomogram for the prediction of cause specific survival for patients with non-metastatic Chromophobe Cell Renal Carcinoma, following radical nephrectomy

Liu

Cai

et al. 2020

Preprint

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Background:The applicability of the nomogram approach to the prognosis of CCRC patients following radical nephrectomy has yet been established or tested. In this study, we utilized data from a large publicly available US cancer database to obtain a large sample size of data on CCRC patients, and used this dataset to evaluate the independent prognostic risk factors for cause-specific survival (CSS) in patients with non-metastatic CCRC. The data were used to construct a new novel prognostic nomogram for CCRC following radical nephrectomy in order to provide a clinically useful predictive tool for estimating a patient's survival probability.This study aimed to establish a novel prognostic nomogram for patients with non-metastatic Chromophobe Cell Renal Carcinoma (CCRC) after radical nephrectomy.Methods:A total of 1040 CCRC patients with non-metastatic cancer who had undergone radical nephrectomy, were identified in SEER (2004 through 2014). A novel nomogram was constructed based on the data and variables associated with cause specific survival time were included in the model using the Cox Proportional-Hazards Model. The nomogram was cross-validated against a subset of the data (n = 520 patients) from 9 randomly selected cancer registries in SEER, by calculation of Harell’s Concordance index (C-index) and the calibration curve for the time-related probability of survival. Results:Multivariate analysis of the training dataset (n = 1040 patients) revealed age at diagnosis, tumor size and tumor grade as independent factors associated with cause specific survival (CSS), and these were selected for inclusion in the nomogram. The calibration curve for the time-limited probability of survival showed good agreement between the predictions of the nomogram and actual observation. The C-index of the nomogram for predicting survival was 0.81 (95% CI 0.75 - 0.87), which was statistically higher than the C-index values produced by the 6/7th AJCC systems (0.75, 95% CI 0.67 - 0.83). The nomogram prediction of survival based on the validation dataset was also superior to that of the 6/7th AJCC staging systems (C-index 0.83 vs. 0.71; P = 0.038 ). Conclusion：The nomogram prediction model we built has a higher C index value, and has better sensitivity and predictive value. A prospective study with a larger sample is needed to verify our findings.

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Ethnic disparities in renal cell carcinoma: An analysis of Hispanic patients in a single‐payer healthcare system

Cited by 24 publications

References 26 publications

Racial and Ethnic Disparities in Renal Cell Carcinoma: An Analysis of Clinical Characteristics

Racial and Ethnic Disparities in Renal Cell Carcinoma: An Analysis of Clinical Characteristics

Racial/ethnic disparities in renal cell carcinoma: Increased risk of early‐onset and variation in histologic subtypes

Development of a novel nomogram for the prediction of cause specific survival for patients with non-metastatic Chromophobe Cell Renal Carcinoma, following radical nephrectomy

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