Disparities in Cancer Specific and Overall Survival Outcomes in African Americans With Renal Cell Carcinoma: Analysis From the International Marker Consortium for Renal Cancer (INMARC)

Published:January 04, 2022DOI:



      To investigate association of African-American race and survival in Renal Cell Carcinoma (RCC).

      Patients and Methods

      We queried the International Marker Consortium for Renal Cancer database for patients who underwent partial or radical (RN) nephrectomy. The cohort was divided into African American (AA) and non-African American (NAA) patients. Primary outcome was all-cause mortality. Secondary outcome was cancer-specific mortality. Multivariable Analysis and Kaplan-Meier Analysis were used to elucidate predictive factors and survival outcomes.


      Three thousand eight hundred and ninety-three patients were analyzed (AA, n = 564/NAA, n = 3329). AA had greater Stage I (73.8% vs 63.9%, P <.001) and papillary RCC (29.8% vs 8.5%, P <.001). Multivariable Analysis revealed increasing age (HR = 1.03, P <.001), AA (HR = 1.24, P = .027), higher stage (HR = 1.30-3.19, P <.001), RN (HR = 2.45, P <.001), clear cell (HR = 1.23, P <.001), positive margin (HR = 1.34, P .004), and high-grade (HR = 1.58, P <.001) to be associated with worsened all-cause mortality. Increasing age (HR = 1.02, P <.001), AA (HR = 1.48, P = .025), RN (HR = 2.98, P <.001), high-grade (HR = 3.11, P <.001), and higher stage (HR = 3.03-13.2, P <.001) were predictive for cancer-specific mortality. Kaplan-Meier Analysis revealed worsened 5-year overall survival for AA in stage I (80% vs 88%, P = .001), stage III (26% vs 70%, P = .001), and stage IV (23% vs 44%, P = .009). Five-year cancer-specific survival was worse for AA in stage III (36% vs 81%, P <.001) and stage IV (30% vs 49%, P = .007).


      Despite presenting with more indolent histology and lower stage, African-Americans were at greater risk for diminished survival, faring worse in overall survival for all stages and cancer-specific survival in for stage III/IV RCC. Further investigation into factors associated with these disparities is warranted.
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        • Znaor A
        • Lortet-Tieulent J
        • Laversanne M
        • et al.
        International variations and trends in renal cell carcinoma incidence and mortality.
        Eur Urol. 2015; 67: 519-530
        • Vaishampayan UN
        • Do H
        • Hussain M
        • et al.
        Racial disparity in incidence patterns and outcome of kidney cancer.
        Urology. 2003; 62: 1012-1017
        • Stafford HS
        • Saltzstein SL
        • Shimasaki S
        • et al.
        Racial/ethnic and gender disparities in renal cell carcinoma incidence and survival.
        J Urol. 2008; 179: 1704-1708
        • Lipworth L
        • McLaughlin JK
        • Tarone RE
        • et al.
        Renal cancer paradox: higher incidence but not higher mortality among African-Americans.
        Eur J Cancer Prev. 2011; 20: 331-333
        • Cotta BH
        • Meagher MF
        • Patil D
        • et al.
        Elevated preoperative C-reactive protein is associated with renal functional decline and non-cancer mortality in surgically treated renal cell carcinoma: analysis from the INternational Marker Consortium for Renal Cancer (INMARC).
        BJU Int. 2021; 127: 311-317
        • Fukushima H
        • Saito K
        • Yasuda Y
        • et al.
        Female gender predicts favorable prognosis in patients with non-metastatic clear cell renal cell carcinoma undergoing curative Surgery: results from the International Marker Consortium for Renal Cancer (INMARC).
        Clin Genitourin Cancer. 2020; 18: 111-116
        • Patel SH
        • Derweesh IH
        • Saito K
        • et al.
        Preoperative elevation of C-reactive protein is a predictor for adverse oncologic survival outcomes for renal cell carcinoma: analysis from the International Marker Consortium Renal Cancer [INMARC].
        Clin Genitourin Cancer. 2021;
        • Amin MB
        • Greene FL
        • Edge SB
        • et al.
        The eighth edition AJCC cancer staging manual: continuing to build a bridge from a population-based to a more "personalized" approach to cancer staging.
        CA Cancer J Clin. 2017; 67: 93-99
        • Sankin A
        • Cohen J
        • Wang H
        • et al.
        Rate of renal cell carcinoma subtypes in different races.
        Int Braz J Urol. 2011; 37: 29-34
        • Chow WH
        • Shuch B
        • Linehan WM
        • et al.
        Racial disparity in renal cell carcinoma patient survival according to demographic and clinical characteristics.
        Cancer. 2013; 119: 388-394
        • Connor WJ
        • Donskov F
        • Fraccon AP
        • et al.
        Characterizing the outcomes of metastatic papillary renal cell carcinoma.
        Cancer Med. 2017; 6: 902-909
        • Rosiello G
        • Palumbo C
        • Knipper S
        • et al.
        Comparison of survival outcomes in patients with metastatic papillary vs. clear-cell renal cell carcinoma: a propensity-score analysis.
        World J Urol. 2021; 39: 461-472
        • Berndt SI
        • Carter HB
        • Schoenberg MP
        • et al.
        Disparities in treatment and outcome for renal cell cancer among older black and white patients.
        J Clin Oncol. 2007; 25: 3589-3595
        • Tripathi RT
        • Heilbrun LK
        • Jain V
        • et al.
        Racial disparity in outcomes of a clinical trial population with metastatic renal cell carcinoma.
        Urology. 2006; 68: 296-301
        • Rose TL
        • Deal AM
        • Krishnan B
        • et al.
        Racial disparities in survival among patients with advanced renal cell carcinoma in the targeted therapy era.
        Cancer. 2016; 122: 2988-2995
        • Schwartz K
        • Ruterbusch JJ
        • Colt JS
        • et al.
        Racial disparities in overall survival among renal cell carcinoma patients with young age and small tumors.
        Cancer Med. 2016; 5: 200-208
        • Marchioni M
        • Harmouch SS
        • Nazzani S
        • et al.
        Effect of African-American race on cancer specific mortality differs according to clear cell vs. non-clear cell histologic subtype in metastatic renal cell carcinoma.
        Cancer Epidemiol. 2018; 54: 112-118
        • Zini L
        • Perrotte P
        • Capitanio U
        • et al.
        Race affects access to nephrectomy but not survival in renal cell carcinoma.
        BJU Int. 2009; 103: 889-893
        • Pal S
        • Tangen C
        • Thompson I
        • et al.
        A comparison of sunitinib with cabozantinib, crizotinib, and savolitinib for treatment of advanced papillary renal cell carcinoma: a randomised, open-label, phase 2 trial.
        Lancet. 2021; 297: 695-703