Survival and treatment of stage IV renal cell carcinoma in academic vs non-academic medical centers.

Background: Renal cell carcinoma (RCC) is treated with surgical resection as the gold standard, as it is notoriously resistant to systemic therapy. Advancements with targeted therapies contribute to declining mortality, but metastatic RCC (mRCC) survival remains poor. One possible factor is treatment at academic centers, which employ advanced providers and novel therapies. This study compared outcomes of mRCC in patients treated at academic/research facilities compared to those treated at non-academic centers.

Aim: To compare survival outcomes of mRCC and their various etiologies between academic and non-academic centers.

Methods: The National Cancer Database was used to identify mRCC patients including all histology subtypes and stage IV disease. Descriptive statistics and Kaplan-Meier curves measured survival outcomes for user file facility types sorted into a binary academic/research and non-academic research variable. Multivariate logistic regression and Cox proportional hazard testing generated odds ratio and hazard ratio. Data was analyzed using Statistical Package for the Social Sciences version 29.0 using a significance level of P < 0.05.

Results: Overall, academic facility patients experienced greater 5-year and 10-year overall survival than non-academic facility patients. Treatment at non-academic facilities was associated with increased odds of death that persisted even after controlling for age, tumor size, sex, and distance traveled to treatment center. In comparison, non-academic facility patients also experienced greater risk of hazard.

Conclusion: Patients with mRCC treated at academic/research facilities experienced increased survival compared to patients treated at non-academic facilities, were more likely to be younger, carry private insurance, and come from a large metropolitan area. They also were significantly more likely to receive surgery and adjuvant immunotherapy.