Cause-specific mortality among patients with renal cell carcinoma in the United States from 2000 to 2018

Recurrence after surgery for clear cell and papillary renal cell carcinoma: Head-to head comparison of validated risk scores

INTRODUCTION

The American Urology Association (AUA) recently introduced in their guidelines a subtype-agnostic, 4-tiered risk classification score to assess oncologic outcomes after surgery in patients with localized renal cell carcinoma (RCC). We provide a head-to-head comparison of the AUA score with 3, internationally validated and EAU recommended, histological-specific models.

MATERIALS AND METHODS

We retrieved from a prospectively-maintained database 2,560 surgically-treated patients with localized RCC in a single high-volume European center (1987-2023). Patients were classified into risk categories, according to 3 histology-specific prognostic models (i.e., Leibovich 2003, Leibovich 2018 and VENUSS). Kaplain-Meier (KM) analyses estimated 5-year progression-free (PFS) and cancer-specific (CSS) survival. Area under curves (AUCs) of each prognostic model to predict clinical progression or cancer-specific mortality (CSM) were calculated, according to histological subtypes.

RESULTS

Overall, 2,145 (84%) patients harbored clear-cell (ccRCC), whereas 415 (16%) harbored papillary (pRCC) RCC. Within ccRCC, proportions of low vs. intermediate vs. high/very-high risk patients ranged from 57 to 58% vs. 17 to 28% vs. 6.3 to 19%, respectively. In pRCC, proportions of low vs. intermediate vs. high/very-high risk patients ranged from 54 to 73% vs. 21 to 24% vs. 4.8 to 12%, respectively. Leibovich 2018 and VENUSS exhibited the highest AUCs for clinical progression (0.805 vs. 0.884) and CSM (0.847 vs. 0.862) prediction within ccRCC vs. pRCC, respectively. The AUA model demonstrated AUCs of 0.783 vs. 0.864 for clinical progression and 0.797 vs. 0.826 for CSM in ccRCC vs. pRCC, respectively.

CONCLUSION

Within a European cohort of RCC patients, the AUA prognostic stratification exhibited reliable performance. Nevertheless, histology-specific models continue to demonstrate a substantial advantage in predicting RCC outcomes.

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. Keywords: advanced renal cell carcinoma, cardiovascular mortality, sex.

Cardiovascular Disease and Other Competing Causes of Death in Older Kidney Cancer Patients

Background

To study the risk of cardiovascular disease (CVD) and other competing causes of death in older kidney cancer patients.

Methods

Data on older patients (aged 65 and above) diagnosed with kidney cancer between 1975 and 2018 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. We delved into the distribution of CVD and other competing causes of death across the entire cohort and in various patient subgroups. The competing risk analysis was used to produce cumulative mortality curves based on cumulative mortality for the primary outcomes by follow-up period. Utilizing the standardized mortality ratios (SMRs) and absolute excess risks (AERs), we contrasted the risk of CVD and other competing causes of death in older kidney cancer patients to that observed in the general population.

Results

The analysis included 29,349 older kidney cancer patients, of which included 4563 CVD deaths. As survival time extended, the proportion of non-cancer deaths increased in older kidney cancer patients, with CVD accounting for the largest share of non-cancer deaths. At 10-15 years after diagnosis, cumulative non-cancer mortality exceeded primary kidney cancer as the predominant cause of death, and cumulative CVD mortality is higher among all non-cancer causes. Older kidney cancer patients exhibited a greater risk of CVD and other non-cancer deaths than their counterparts in the general older population did (SMR: 1.38-2.81; AER: 1.1-143.69).

Conclusions

As survival time increases, the risk of non-cancer death in older kidney cancer patients gradually surpassed that of primary cancer, and CVD death accounted for the majority of non-cancer deaths. Among older kidney cancer patients, the risk of CVD mortality was higher than in the general population. Managing non-cancer deaths, especially CVD deaths, should be a focus in the care of older kidney cancer patients.

Exploring the Role of Intracorporeal Ultrasound in Partial Nephrectomies: A Systematic Review

Renal cell carcinoma accounts for the sixth most common cancer in the United Kingdom. With the increasing application of cross-sectional imaging, the frequency of incidental renal masses has increased over time. Laparoscopic and robot-assisted partial nephrectomy has become the standard of care in the management of size and stage-appropriate renal masses. The objective of this systematic review was to analyse the surgical outcomes when intracorporeal ultrasound was utilised as an adjunct in partial nephrectomy. A comprehensive search in PubMed and Google Scholar was performed in July 2024 for publications in the English language. The primary endpoint was to evaluate the role of intracorporeal ultrasound as an adjunct in robotic partial nephrectomies and its impact on tumour clearance. After identifying 609 records, 52 records were screened and 44 records were sought for retrieval. Eight publications were included in this systematic review comprising 765 patients. Seven of the eight studies reported outcomes from single centres. The mean percentage of negative surgical margins was 97.6% (range = 92.1-100%). The use of intracorporeal ultrasound as an adjunct in partial nephrectomy for T1 renal cell cancer has proven to improve the rates of negative surgical margins thereby reducing the incidence of local recurrence and distant metastasis.

A Bayesian competing risk analysis of renal cancer patients based on SEER database

BACKGROUND

Renal cell carcinoma (RCC) remains a global health concern due to its poor survival rate. This study aimed to investigate the influence of medical determinants and socioeconomic status on survival outcomes of RCC patients. We analyzed the survival data of 41,563 RCC patients recorded under the Surveillance, Epidemiology, and End Results (SEER) program from 2012 to 2020.

METHODS

We employed a competing risk model, assuming lifetime of RCC patients under various risks follows Chen distribution. This model accounts for uncertainty related to survival time as well as causes of death, including missing cause of death. For model analysis, we utilized Bayesian inference and obtained the estimate of various key parameters such as cumulative incidence function (CIF) and cause-specific hazard. Additionally, we performed Bayesian hypothesis testing to assess the impact of multiple factors on the survival time of RCC patients.

RESULTS

Our findings revealed that the survival time of RCC patients is significantly influenced by gender, income, marital status, chemotherapy, tumor size, and laterality. However, we observed no significant effect of race and origin on patient's survival time. The CIF plots indicated a number of important distinctions in incidence of causes of death corresponding to factors income, marital status, race, chemotherapy, and tumor size.

CONCLUSIONS

The study highlights the impact of various medical and socioeconomic factors on survival time of RCC patients. Moreover, it also demonstrates the utility of competing risk model for survival analysis of RCC patients under Bayesian paradigm. This model provides a robust and flexible framework to deal with missing data, which can be particularly useful in real-life situations where patients information might be incomplete.

Causes of death and nomogram for patients with oncologic hepato-biliary-pancreatic disorders: A large-cohort study

The improvement of digestive cancer survival results in increased morbidity of noncancerous comorbidities. This study aimed at clarifying causes of death (COD) and predicting overall survival (OS) in patients diagnosed with liver cancer, gallbladder cancer, cholangiocarcinoma, and pancreatic cancer. We used the Surveillance, Epidemic, and End Results database to extract information. Nomograms of multivariate Cox regression was used to predict OS of cancer patients. The models were evaluated using the concordance indexes (C-indexes), the receiver operating characteristic curves and calibration curves. Respectively 58,895, 15,324, 30,708, and 109,995 cases with cancer of liver, gallbladder, bile duct or pancreas were retrieved between 2000 and 2020. Approximately 80% deaths occurred within 1 years after cancer diagnosis. Sequence in noncancerous COD proportion was diverse, while diseases of heart always accounted for a great part. Risks of death from most noncancerous COD were significantly higher than that of the cancer-free population. Nomograms were developed by predictors of interest such as age, therapy and TNM stage. The concordance indexes of nomograms were 0.756, 0.729, 0.763, and 0.760 respectively, well-calibrating to the reality. The 0.5-, 1-, and 2-year areas under the receiver operating characteristic curve were about 0.800, indicating good reliability and accuracy. Noncancerous COD accounted for larger part in gallbladder cancer and cholangiocarcinoma. Noncancerous COD showed an upward trend as follow-up time extended and the majorities were diseases of heart, cerebrovascular disease, chronic liver disease and cirrhosis. The novel OS-nomograms can provide personalized prognosis information with satisfactory accuracy.