Cause of Death During Renal Cell Carcinoma Survivorship: A Contemporary, Population-Based Analysis

Dong-Dong Yu; Wei-Kang Chen; Chen-Yu Wu; Wan-Ting Wu; Xiao Xin; Yu-Li Jiang; Peng Li; Ming-Hua Zhang

doi:10.3389/fonc.2022.864132

Cause of Death During Renal Cell Carcinoma Survivorship: A Contemporary, Population-Based Analysis

Front Oncol. 2022 Jun 2:12:864132. doi: 10.3389/fonc.2022.864132. eCollection 2022.

Authors

Dong-Dong Yu¹, Wei-Kang Chen², Chen-Yu Wu³, Wan-Ting Wu⁴, Xiao Xin¹, Yu-Li Jiang¹, Peng Li¹, Ming-Hua Zhang¹

Affiliations

¹ Department of Urology, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, China.
² Department of Reproductive Endocrinology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
³ Department of Orthopaedic Surgery, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
⁴ Department of Clinical Medicine, Huzhou University, Huzhou, China.

Abstract

Background: As the survival rates of patients with renal cell carcinoma (RCC) continue to increase, noncancer causes of death cannot be ignored. The cause-specific mortality in patients with RCC is not well understood.

Objective: Our study aimed to explore the mortality patterns of contemporary RCC survivors.

Methods: We performed a retrospective cohort study involving patients with RCC from the Surveillance, Epidemiology, and End Results (SEER) database. We used standardized mortality ratios (SMRs) to compare the death rates in patients with RCC with those in the general population.

Results: A total of 106,118 patients with RCC, including 39,630 who died (27%), were included in our study. Overall, compared with the general US population, noncancer SMRs were increased 1.25-fold (95% confidence intervals [CI], 1.22 to 1.27; observed, 11,235), 1.19-fold (95% CI, 1.14 to 1.24; observed, 2,014), and 2.24-fold (95% CI, 2.11 to 2.38; observed, 1,110) for stage I/II, III, and IV RCC, respectively. The proportion of noncancer causes of death increased with the extension of survival time. A total of 4,273 men with stage I/II disease (23.13%) died of RCC; however, patients who died from other causes were 3.2 times more likely to die from RCC (n = 14,203 [76.87%]). Heart disease was the most common noncancer cause of death (n = 3,718 [20.12%]; SMR, 1.23; 95% CI, 1.19-1.27). In patients with stage III disease, 3,912 (25.98%) died from RCC, and 2,014 (13.37%) died from noncancer causes. Most patients (94.99%) with stage IV RCC died within 5 years of initial diagnosis. Although RCC was the leading cause of death (n = 12,310 [84.65%]), patients with stage IV RCC also had a higher risk of noncancer death than the general population (2.24; 95% CI, 2.11-2.38).

Conclusions: Non-RCC death causes account for more than 3/4 of RCC survivors among patients with stage I/II disease. Patients with stage IV are most likely to die of RCC; however, there is an increased risk of dying from septicemia, and suicide cannot be ignored. These data provide the latest and most comprehensive assessment of the causes of death in patients with RCC.

Keywords: Epidemiology; Surveillance; and End Results (SEER); cause of death; noncancer cause of death; renal cell cancer; standardized mortality ratios (SMRs).