Disparities in the Treatment and Survival of Metastatic Renal Cell Carcinoma

Objective: To evaluate racial, gender, and socioeconomic differences in the treatment of metastatic renal cell carcinoma (mRCC) and their impact on survival. Methods: Patients aged ≥18 years diagnosed with mRCC in the National Cancer Database (2004-2015) were analyzed. Multivariable logistic regression models were used to evaluate factors associated with systemic therapy and cytoreductive nephrectomy (CN) utilization. Cox proportional hazards regression models were used to evaluate overall survival. Results: In total, 31,989 patients with mRCC were identified with 30.2% receiving CN, 51.6% receiving systemic therapy, and 25.8% receiving no treatment. Females were at lower odds of receiving systemic therapy (OR 0.91, P <.01) and increased odds of no treatment (OR 1.14, P <.01). Non-Hispanic Black and Hispanic patients were at decreased odds of receiving CN (OR 0.75, P <.01 and OR 0.86, P = .01, respectively). Black patients were at decreased odds of receiving systemic therapy (OR 0.85, P <.01) and increased odds of no treatment (OR 1.41, P <.01). Adjusting for demographic and disease variables, Black patients were at increased risk of death (HR 1.06, P = .03), largely due to less use of systemic therapy and CN; survival differences disappeared after accounting for receipt of therapy (HR 0.99, P = .66). Conclusion: There are racial, gender, and socioeconomic differences in the treatment of mRCC which are associated with a disparity in overall survival. Dismantling systemic barriers and improving access to care may lead to reduced disparities and improved outcomes for mRCC.