Disparities in survival outcomes in African Americans in renal cell carcinoma: Impact of oncological versus nononcological factors.

2019 ◽  
Vol 37 (7_suppl) ◽  
pp. 595-595
Author(s):  
Margaret Frances Meagher ◽  
Aaron Bradshaw ◽  
David Anyakora ◽  
Dattatraya H Patil ◽  
Kazutaka Saito ◽  
...  
Keyword(s):  
Overall Survival ◽  
African American ◽  
African Americans ◽  
Cancer Mortality ◽  
Tumor Size ◽  
Radical Nephrectomy ◽  
Functional Decline ◽  
Tumor Grade ◽  
Survival Outcomes ◽  
African American Race

595 Background: African-Americans have increased incidences of renal cortical tumor subtypes of lower oncological potential in the setting of lower risk disease when compared to other ethno-racial groups. However, survival outcomes are similar. We investigated the impact of African-American race on overall survival, oncological outcomes, functional outcomes, and non-cancer mortality. Methods: Multi-institutional retrospective analysis of patients who underwent partial or radical nephrectomy between 1998-2018. Primary outcome was overall survival (OS). Secondary outcomes included non-cancer mortality (NCM), recurrence free survival (RFS), and estimated glomerular filtration rate (eGFR) decline. Multivariable logistic regression (MVA) were used to elucidate predictive factors for OS, NCM, and RFS, and eGFR <45 and <30 ml/min/1.73m2. Results: 3,088 patients were divided into African American (AA, n=353) and Non-African American (NAA, n=2735) sub-groups. No difference was noted between groups with respect to mean tumor size (p=0.211) or metastases presence (p=0.846). African-American race was an independent risk factor for functional decline to eGFR<45 (OR 4.43, p<0.001) and eGFR<30 (OR 5.15, p<0.001). MVA for worsened NCM demonstrated African-American race (OR=1.72, p=0.042), increasing age (OR=1.03, p=0.001), radical nephrectomy (OR=2.98, p<0.001), and increasing tumor size (OR=1.26, p<0.001) to be independent risk factors. MVA for worsened OS included increasing age (OR=1.04, p<0.001), tumor size (OR=1.182, p<0.001), clear cell histology (OR=1.62, p<0.001), high tumor grade (OR=2.12, p<0.001), and post-operative eGFR <45 (OR=2.12, p<0.001). MVA for worsening RFS demonstrated high tumor grade (OR=2.38, p<0.001) and increasing clinical tumor size (OR=1.152, p<0.001) to be independent factors. Conclusions: African Americans undergoing renal surgery for RCC appear to have similar OS and RFS, but poorer NCM than non-African American patients. The cause of these disparities is multi-faceted and likely associated with functional decline. Nephron-sparing management should be considered in African-Americans presenting with renal cortical tumors.

Impact of oncological versus nononcological on survival outcomes in African Americans with renal cell carcinoma.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 749-749
Author(s):  
Margaret Frances Meagher ◽  
Aaron Bradshaw ◽  
Dattatraya H Patil ◽  
Kazutaka Saito ◽  
Brittney Cotta ◽  
...  
Keyword(s):  
Overall Survival ◽  
African American ◽  
African Americans ◽  
Cancer Mortality ◽  
Tumor Size ◽  
Radical Nephrectomy ◽  
De Novo ◽  
Functional Decline ◽  
Tumor Grade ◽  
Survival Outcomes

749 Background: African-Americans have an increased incidence of renal tumors of lower oncological potential when compared to other ethno-racial groups. Yet, survival outcomes are similar. We investigated the impact of African-American race on overall survival, oncological and functional outcomes, and non-cancer mortality. Methods: Multi-institutional (Emory, TMDU, UCSD) retrospective analysis of patients who underwent partial or radical nephrectomy between 1998-2018. Primary outcome was overall survival (OS). Secondary outcomes were non-cancer mortality (NCM), recurrence free survival (RFS), and eGFR decline. Multivariable logistic regression (MVA) was used to analyze OS, NCM, and RFS, and estimated glomerular filtration rate (eGFR)<45 and <30 ml/min/1.73m2. Results: 3632 patients were grouped into African American (AA, n=531) and Non-African American (NAA, n=3101). No difference was noted between groups with respect to mean tumor size (p=0.31). NAA had a higher proportion of metastases at presentation (9.9% vs. 7.0%, p=0.04). AA race was an independent risk factor for functional decline to de novo eGFR <45 (OR=1.43, p=0.04) and de novo eGFR<30 (OR 2.01, p<0.001). MVA for worsened NCM demonstrated AA race (OR=1.63, p=0.02), increasing age (OR=1.05, p<0.001), male sex (OR=1.56, p=0.01), and hypertension (OR=1.73, p=0.001) to be independent risk factors. Significant factors on MVA for worsened OS included increasing age (OR=1.03, p<0.001), radical nephrectomy (OR=1.47, p=0.01), increasing tumor size (OR=1.11, p<0.001), hypertension (OR=2.63, p<0.001), high tumor grade (OR=1.97, p<0.001), and post-operative eGFR <45 (OR=1.50, p=0.01). MVA for worsening RFS demonstrated high tumor grade (OR=2.04, p<0.001) and increasing clinical tumor size (OR=1.15, p<0.001) to be independent factors. Conclusions: African Americans undergoing surgical management for RCC appear to have similar OS and RFS, but poorer NCM than non-African American patients. The cause of these disparities is multi-faceted but likely is associated with functional decline. Nephron-sparing management when feasible and appropriate should be considered in African-Americans presenting with renal cortical tumors.

scholarly journals Overall Survival Prediction in Renal Cell Carcinoma Patients Using Computed Tomography Radiomic and Clinical Information

2021 ◽  
Author(s):  
Zahra Khodabakhshi ◽  
Mehdi Amini ◽  
Shayan Mostafaei ◽  
Atlas Haddadi Avval ◽  
Mostafa Nazari ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Overall Survival ◽  
Cell Carcinoma ◽  
Clinical Features ◽  
Renal Cell ◽  
Radical Nephrectomy ◽  
Clinical Information ◽  
Tumor Grade ◽  
Imaging Biomarkers ◽  
Area Density

AbstractThe aim of this work is to investigate the applicability of radiomic features alone and in combination with clinical information for the prediction of renal cell carcinoma (RCC) patients’ overall survival after partial or radical nephrectomy. Clinical studies of 210 RCC patients from The Cancer Imaging Archive (TCIA) who underwent either partial or radical nephrectomy were included in this study. Regions of interest (ROIs) were manually defined on CT images. A total of 225 radiomic features were extracted and analyzed along with the 59 clinical features. An elastic net penalized Cox regression was used for feature selection. Accelerated failure time (AFT) with the shared frailty model was used to determine the effects of the selected features on the overall survival time. Eleven radiomic and twelve clinical features were selected based on their non-zero coefficients. Tumor grade, tumor malignancy, and pathology t-stage were the most significant predictors of overall survival (OS) among the clinical features (p < 0.002, < 0.02, and < 0.018, respectively). The most significant predictors of OS among the selected radiomic features were flatness, area density, and median (p < 0.02, < 0.02, and < 0.05, respectively). Along with important clinical features, such as tumor heterogeneity and tumor grade, imaging biomarkers such as tumor flatness, area density, and median are significantly correlated with OS of RCC patients.

Clinical Characteristics, Pathology and Outcome of 237 Patients With Synovial Sarcoma: Single Center Experience

2021 ◽  
pp. 106689692110560
Author(s):  
Hao Cheng ◽  
Chi Yihebali ◽  
Hongtu Zhang ◽  
Lei Guo ◽  
Susheng Shi
Keyword(s):  
Overall Survival ◽  
Synovial Sarcoma ◽  
Tumor Size ◽  
Clinical Characteristics ◽  
Cox Regression ◽  
Survival Outcomes ◽  
Tumor Diameter ◽  
Single Center ◽  
Primary Tumors ◽  
Cox Regression Analysis

Background Synovial sarcoma (SS) is a rare soft tissue sarcoma. Available data regarding survival outcomes of patients with SS still remains limited. In this study, a single center retrospective analysis was performed to investigate the clinical characteristics, pathology and survival outcomes in patients with SS in China. Methods Patient data were systematically reviewed at the National Cancer Center from January 2015 to December 2020. The general information and treatment condition of patients were collected. Overall survival (OS) was evaluated using the Kaplan-Meier and Cox regression method. Results A total of 237 consecutive patients were included in this study (follow-up cut-off date: December, 2020). The median age of patients involved was 35 years (ranging from 5 to 83 years) and the mean tumor diameter was 5.3 cm (ranging from .2 to 26.0 cm). The main findings of the immunohistochemical staining analyses were EMA (111/156) (71%), keratin (32/64) (50.0%), keratin (12/20) (60%), keratin (42/70) (60%), S-100 (18/160) (11%), BCL-2 (128/134) (96%), CD99 (137/148) (93%) and TLE1 (23/26) (88%). It was found that 109 patients (66%) were presented with monophasic subtype and 55 (34%) with biphasic subtype. A total of 137 patients were tested by FISH method and 119 patients (87%) demonstrated SS18 rearrangement, whereas 18 patients (13%) did not show SS18 rearrangement. Generally, it was found that the 3-year OS rate was 86% and the 3-year DFS was 55%. Results of univariate analysis revealed that age, tumor size, tumor site, radiotherapy and targeted therapy were significantly correlated with the overall survival ( P < .05). Further, multivariate Cox regression analysis revealed that age, tumor size and radiotherapy were significantly associated with OS ( P < .05). Conclusions In conclusion, this study shows that the outcomes of patients with SS significantly decrease with age and tumor size. It was evident that radiotherapy is an independent and positive prognostic factor for patients with SS. In addition, it was shown that the prognosis of SS varies with tumor location. For instance, primary tumors in lower extremities have a higher prognosis, whereas tumors located in thorax have a lower prognosis.

scholarly journals African-American race and mortality in interstitial lung disease: a multicentre propensity-matched analysis

2018 ◽  
Vol 51 (6) ◽  
pp. 1800255 ◽  
Author(s):  
Ayodeji Adegunsoye ◽  
Justin M. Oldham ◽  
Shashi K. Bellam ◽  
Jonathan H. Chung ◽  
Paul A. Chung ◽  
...  
Keyword(s):  
African American ◽  
African Americans ◽  
Interstitial Lung Disease ◽  
Propensity Score ◽  
Lung Disease ◽  
Survival Time ◽  
Sensitivity Analyses ◽  
Younger Age ◽  
All Cause Mortality ◽  
African American Race

We studied whether African-American race is associated with younger age and decreased survival time at diagnosis of interstitial lung disease (ILD).We performed a multicentre, propensity score-matched analysis of patients with an ILD diagnosis followed at five US hospitals between 2006 and 2016. African-Americans were matched with patients of other races based on a time-dependent propensity score calculated from multiple patient, physiological, diagnostic and hospital characteristics. Multivariable logistic regression models were used. All-cause mortality and hospitalisations were compared between race-stratified patient cohorts with ILD, and sensitivity analyses were performed.The study included 1640 patients with ILD, 13% of whom were African-American, followed over 5041 person-years. When compared with patients of other races, African-Americans with ILD were younger at diagnosis (56 years versus 67 years), but in the propensity-matched analyses had greater survival (hazard ratio 0.46, 95% CI 0.28–0.77; p=0.003) despite similar risk of respiratory hospitalisations (relative risk 1.04, 95% CI 0.83–1.31; p=0.709), and similar GAP-ILD (gender–age–physiology-ILD) scores at study entry. Sensitivity analyses in a separate cohort of 9503 patients with code-based ILD diagnosis demonstrated a similar association of baseline demographic characteristics with all-cause mortality.We conclude that African-Americans demonstrate a unique phenotype associated with younger age at ILD diagnosis and perhaps longer survival time.

Racial differences in survival outcomes among men with localized prostate cancer.

2013 ◽  
Vol 31 (6_suppl) ◽  
pp. 98-98
Author(s):  
Grace L. Lu-Yao ◽  
Dirk Moore ◽  
Yong Lin ◽  
Kitaw Demissie ◽  
Weichung Shih ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
African Americans ◽  
Racial Differences ◽  
Cancer Mortality ◽  
Cancer Survival ◽  
African American Men ◽  
Localized Prostate Cancer ◽  
Survival Outcomes ◽  
Study Cohort ◽  
Prostate Cancer Mortality

98 Background: This study addresses whether the recent favorable survival trends observed among contemporary prostate cancer patients can be extended to African American men who have historically suffered excess prostate cancer mortality. Methods: The study cohort consisted of men over age 65, who resided in the SEER catchment area and were diagnosed with T1-T2 prostate cancer (ICD-O-3 code C61.9) during the period 1992-2005. In order to quantify race-specific prostate cancer mortality, separate competing risk models were fit separately for Whites and Blacks. Results: This study includes 35,509 white men and 5,256 black men who received conservative management for localized prostate cancer. The median age of the patients is 76 years at diagnosis and the median follow-up is 106 months. Overall, African Americans have slightly higher adjusted prostate cancer mortality than Whites (hazard ratio [HR] =1.16; 95% confidence interval [C.I.] 1.03 – 1.29). The racial difference was more pronounced in men with moderately differentiated cancer (HR=1.24, 95% CI 1.05 – 1.45), compared to poorly differentiated cancer (HR=1.00, 95% C.I. 0.85 – 1.18). Further analyses by comorbidity status and income level revealed that African Americans and Whites have similar excellent prostate cancer survival if they lived in areas with incomes above the median. Conclusions: African Americans diagnosed in the contemporary PSA era have similarly excellent survival outcomes as their white counterparts if they lived in areas with incomes above the median. Further studies should be conducted to confirm these findings and assess care and health habits that may improve cancer control and outcomes among African Americans.

scholarly journals What precipitates depression in African-American cancer patients? Triggers and stressors

2012 ◽  
Vol 10 (4) ◽  
pp. 279-286 ◽  
Author(s):  
Amy Y. Zhang ◽  
Faye Gary ◽  
Hui Zhu
Keyword(s):  
African American ◽  
African Americans ◽  
Cancer Patients ◽  
Racial Differences ◽  
Cancer Diagnosis ◽  
Functional Decline ◽  
Group Differences ◽  
Data Set ◽  
Exact Test ◽  
Prostate Cancer Survivors

AbstractObjective:This study examined general and cancer-related stressors of depression that are unique to African-American cancer patients.Method:The study used cohort design and mixed methods. Seventy-four breast and prostate cancer survivors including 34 depressed and 23 non-depressed African-Americans and 17 depressed whites were interviewed. Qualitative data analysis identified themes. The thematic codes were converted to a SPSS data set numerically. The Fisher's exact test was performed to examine group differences in the experience of stress.Results:Significantly more depressed African-Americans experienced a dramatic reaction to a cancer diagnosis (p = 0.03) or had concerns about functional decline (p = 0.01), arguments with relatives or friends (p = 0.02), and unemployment status (p = 0.03) than did non-depressed African-Americans, who reacted to the cancer diagnosis as a matter of reality (p = 0.02). Significantly more depressed African-Americans talked about feeling shocked by a cancer diagnosis (p = 0.04) and being unable to do things that they used to do (p = 0.02) than did depressed whites. Qualitative analysis shed light on the extent of such group differences.Significance of results:Distress from the initial cancer diagnosis and functional decline were likely to have triggered or worsened depression in African-American cancer patients. This study highlighted racial differences in this aspect. It is critical to screen African-American cancer patients for depression at two critical junctures: immediately after the disclosure of a cancer diagnosis and at the onset of functional decline. This will enhance the chance of prompt diagnosis and treatment of depression in this underserved population.

scholarly journals Minority Health Disparities in Acute Myeloid Leukemia: A Metropolitan, Single-Center Retrospective Analysis

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 1987-1987
Author(s):  
Keri R. Maher ◽  
Ian M. Bouligny
Keyword(s):  
Overall Survival ◽  
Acute Myeloid Leukemia ◽  
African American ◽  
African Americans ◽  
Myeloid Leukemia ◽  
Insurance Coverage ◽  
Rank Test ◽  
Log Rank Test ◽  
Disease Biology ◽  
Acute Myeloid

Abstract Background: Acute myeloid leukemia (AML) is an aggressive bone marrow cancer affecting 20,000 adults in the United States yearly. Five-year relative survival remains poor at 29.5%, though this has been steadily increasing. There are no known differences in diagnostic rates between racial and ethnic groups. Previous work has shown being African American is an independent predictor of poorer survival - particularly in impoverished areas and those with Medicaid. We aimed to identify potential racial disparities amongst our AML population - with special attention to insurance coverage, access to care, disease biology, regimen selection, toxicities, referral for allogeneic hematopoietic stem cell transplant (alloHSCT), and overall survival with non-Hispanic Whites as a control. Methods: This study is a retrospective analysis of patients diagnosed with AML and treated at Virginia Commonwealth University/Massey Cancer Center identified by our data analytics core from June 2018 to December 2020. Data were extracted and manually verified from the electronic medical record into an AML database instrument created in RedCap. Race was determined by self-report. Statistical analysis was performed using GraphPad Prism. Descriptive and inferential statistics were performed with comparisons between groups using an unpaired t-test with Welch's correction or with Fischer's exact test. Overall survival rates were evaluated using Kaplan-Meier analyses and compared using log-rank test. The event date was death and patients were otherwise censored at the date of last contact. Results: Our cohort consisted of 160 patients: 26.3% African Americans, 68.8% Whites, 1.9% Hispanic/Latinos, 1.9% other or declined to state, and 1.3% were unknown. To analyze the impact of minority populations, Hispanic/Latino and "other" categories were combined with African American into a "Non-White" cohort (N = 48) and compared to the "White" cohort (N = 110). There was no baseline difference in age (p= 0.212), Charleson Comorbidity Index (CCI) at presentation (p = 0.692), or ECOG status (p = 0.920) at presentation (Table 1). Assessment of disease biology, including European Leukemia Network risk stratification (p = 0.507), presence of complex karyotype (p = 0.366) and presence of TP53 mutations (p = 0.776) did not detect a statistically significant difference between the two groups (Table 1). Choice of intensive (vs non-intensive) induction based on physician's discretion was also similar (62.5% in non-White, 68.2% in Caucasians, p = 0.583). Toxicity analysis such as ICU during induction (p = 0.519) and death within 60 days of induction (p = 0.8) showed no difference between groups. In parameters assessing access to care, non-Whites were more likely than Whites to have either Medicaid or no insurance coverage, opposed to private insurance or Medicare (p = 0.0166). Despite this, there was no difference in overall survival assessed by log-rank test (p = 0.068) across all cytogenetic cohorts or with respect to the adverse risk cohort (p = 0.143), though the non-White cohort had a mOS of 286 days (9.4 months) compared to 764 days (25.1 months) in the White cohort. Rates of being lost to follow up were not different between the two groups (p = 0.34). However, rates of alloHSCT were approaching significance with p = 0.0528 favoring Caucasians. Discussion: Our data suggest similar disease biology at presentation amongst racial and ethnic groups, as well as similar comorbidities, performance status at diagnosis, and choice of induction regimen. As previous research has shown, our minority cohort was more likely to have no insurance or Medicaid than the Caucasian population. However, this did not lead to a statistically significant overall survival difference. Rates of alloHSCT were approaching statistical significance between the groups. This suggests that improving access to transplant might be one of the more effective tools for improving outcomes in this group. Additionally, demographics in the Richmond metro area demonstrate a population of 47% African American and 48% Whites, whereas our data showed 26% African Americans and 69% Whites, with no known strong racial predilection of AML based on SEER data (46% vs 54%, respectively). Thus, concern remains that there may be a significant number of patients with AML who either do not seek care, or present in a condition where treatment is no longer possible. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

scholarly journals Radical Nephrectomy Provides a Worse Prognosis Than Partial Nephrectomy in T3aN0M0 Renal Cancer of Small (≤4 cm) Size and No Invasion of Perisinus Fat

2020 ◽  
Author(s):  
Shiliang Liu ◽  
Zhixian Wang ◽  
Chang Liu
Keyword(s):  
Overall Survival ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Partial Nephrectomy ◽  
Tumor Size ◽  
Radical Nephrectomy ◽  
Risk Of Death ◽  
Recommended Treatment ◽  
Risk Of Mortality ◽  
Significant Difference

Abstract Background: Radical nephrectomy (RN) is the recommended treatment for T3aN0M0 renal cell carcinoma (RCC). However, it is not necessarily the best treatment for small T3aN0M0 RCCs. We evaluated the effect of tumor size combined with consideration of anatomic types of extrarenal-fat invasion on the surgical decision-making between partial nephrectomy (PN) vs. RN in T3aN0M0 RCC.Methods: Data were obtained from the Surveillance, Epidemiology, and End Results database (2004 to 2015) with 6125 patients suffering from T3aN0M0 RCC. Cox and Fine and Gray models were used for survival analyses. Propensity-score matching was used for PN vs. RN.Results: A larger T3aN0M0 RCC was associated with higher risk of mortality (hazard ratio (HR)all-cause mortality: 1.07, 95% confidence interval (CI): 1.02–1.13, P = 0.011; HRRCC-cause mortality: 1.13, 95%CI: 1.06–1.21, P < 0.001) compared with a small T3aN0M0 RCC. After propensity-score matching, in T3aN0M0 ≤4 cm, RN compared with PN significantly increased the risk of death (HR: 1.77; 95%CI: 1.14–2.74, P = 0.011) and offered no significant difference in RCC-specific survival (HR: 1.57, 95%CI: 0.74–3.36, P = 0.240). However, RN and PN showed no significant difference in overall survival in T3aN0M0 RCC >4 cm (HR: 0.98; 95%CI: 0.59–1.62, P= 0.929) or in T3aN0M0 RCC with sinus/perisinus-fat invasion (HR: 1.18; 95%CI: 0.61–2.27, P = 0.631).Conclusion: PN provided better overall survival compared with RN for small (≤4 cm) T3aN0M0 RCCs without sinus/perisinus-fat invasion. Focusing only on anatomic-invasion characteristics rather than type and tumor size is not sufficient for treatment decisions in T3aN0M0 RCC.

Sign in / Sign up

Export Citation Format

Share Document