Racial Differences in Survival for Locally Advanced Renal Cell Carcinoma.

Introduction: African Americans with renal cell carcinoma (RCC) often have more aggressive tumors and worse outcomes compared to other racial groups. The impact of race on survival in locally advanced RCC with tumor thrombus and metastatic RCC (mRCC) remains unclear. This study evaluates racial disparities in survival among RCC patients with tumor thrombus.

Methods: This IRB-approved retrospective study analyzed 11,520 RCC patients aged 18 to 80 with tumor thrombus who underwent nephrectomy (2010-2015) using the National Cancer Database. Demographic factors (age, sex, race/ethnicity) and clinical variables (tumor stage, grade, thrombus level, surgery type, comorbidities) were included. Statistical analyses utilized Kaplan-Meier curves, Cox proportional hazards, and multinomial logistic regression, with significance set at P < .05.

Results: African Americans (6% of patients) had a 22% higher overall mortality hazard (HR: 1.22, P < .001) and 24% higher hazard in metastatic RCC (HR: 1.24, P = .019) compared to non-Hispanic Whites (83%). Five-year survival rates for advanced thrombus levels (I-IV) were comparable between races. Overall mortality was 55%, rising to 82% in metastatic cases.

Conclusion: Among patients with RCC and tumor thrombus, African American patients face 22% higher mortality hazard compared to non-Hispanic white patients. They often present with more locally advanced disease and mRCC. The mortality hazard for metastatic RCC is increased by 24% among African Americans compared to Caucasians. The results highlight the demographic impact of race and supports clinical consideration when managing African American patients.