Trend of cardiovascular mortality among metastatic renal cell cancer patients in the US from 2005 to 2020

Recent advances in treating advanced renal cell carcinoma (RCC) with distant metastasis have significantly enhanced cancer-specific outcomes. However, these patients are at increased risk for cardiovascular disease (CVD) and events. This study aims to investigate the trend of incidence-based mortality specific to CVD in patients with metastatic RCC. We examined data from 26,501 adult patients aged 18 and older diagnosed with metastatic RCC between 2005 and 2020 in the Surveillance, Epidemiology, and End Results (SEER) 17 registry. We used a linear regression model to examine trends in metastatic RCC incidence and mortality rates among the US general population stratified by gender using R statistical software version 4.3.2. Among 26,501 adult patients diagnosed with metastatic RCC, RCC-specific mortality accounted for 18,258 (81.1 %) deaths, while mortality due to cardiovascular (CV) events was 737 (3.3 %). The overall incidence rate of metastatic RCC increased over time (p-value < 0.001). A significant interaction between time and sex was found, indicating greater increase in metastatic RCC incidence rates in males than females over time (p < 0.001 for interaction). There was no statistically significant difference in metastatic RCC-specific mortality rate between sexes (p = 0.25) or over time (p = 0.89). The combined CV mortality rate (in both sexes) increased from 0.02 to 0.04 during the years 2005–2020 and was statistically significant (p = 0.001) with no significant difference in mortality between sexes (p = 0.13). The trend of increasing metastatic RCC incidence with no change in all cause and metastatic RCC specific mortality would suggest benefit of advances in therapy. However, the slow but gradual rise in CV mortality needs to be further studied.