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Incidence and survival rates of the three major histologies of renal cell carcinoma

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Incidence and survival rates of the three major histologies of renal cell carcinoma

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Content Copyright 2022 Claire Yang Bai

INCIDENCE AND SURVIVAL RATES OF THE THREE MAJOR HISTOLOGIES OF
RENAL CELL CARCINOMA:
A DESCRIPTIVE EPIDEMIOLOGIC ANALYSIS BY SEX, RACE/ETHNICITY,
LATERALITY OF OCCURRENCE AND STAGE AT DIAGNOSIS USING SEER DATA

by

Claire Yang Bai

A Thesis Presented to the
FACULTY OF THE USC KECK SCHOOL OF MEDICINE
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
MASTER OF SCIENCE
[APPLIED BIOSTATISTICS AND EPIDEMIOLOGY]

August 2022

ii
Acknowledgments

I would like to thank my thesis committee chair and members, Dr. Victoria Cortessis, Dr.
Wendy Mack, and Dr. Sia Daneshmand, for their invaluable guidance, expertise and patience
throughout the development of this thesis. I would also like to acknowledge all my professors,
teaching assistants, and peers, whom I learned so much from and befriended during my six years
as a student under the Department of Population and Public Health Sciences, for enriching a
thorough education that helped pave my way into epidemiology and biostatistics. Finally, I
would like to thank my parents for emphasizing the importance of learning and always
encouraging me to reach higher. I wouldn’t be here without your lifelong support.

iii
Table of Contents
Acknowledgments………………………………………………………………………………..ii
List of Tables……………………………………………………………………………………..iv
List of Figures……………………………………………………………………………………..v
Abstract…………………………………………………………………………………………..vii
Chapter One: Introduction………………………………………………………………………...1
Chapter Two: Methods……………………………………………………………………………5
Chapter Three: Results………………………………………………………………………….....8
Chapter Four: Discussion………………………………………………………………………...28
References………………………………………………………………………………………..34
Appendix…………………………………………………………………………………………36
Appendix A………………………………………………………………………………36
Supplementary Incidence Figures………………………………………………………..36
Appendix B………………………………………………………………………………47
Supplementary Survival Tables………………………………………………………….47

iv
List of Tables
Table 1. Renal Cell Carcinoma: Zero-knot Joinpoint Regression Average Annual Percent
Change (AAPC, %), According to Histology and Sex (From AAIRs in NPCR + SEER Data,
2001-2018)………………………………………………………………………………………...8

v
List of Figures
Figure 1. Renal Cell Carcinoma: Age-Adjusted Incidence Rates (AAIRs) Reported to NPCR and
SEER Registries, According to Histology, Sex, and Year of Diagnosis, 2001-2018 …………….8
Figure 2. Renal Cell Carcinoma: Age-Adjusted Incidence Rates (AAIRs) Reported to NPCR and
SEER Registries, According to Histology, Sex, and Race/Ethnicity, 2001-2018 ………………..9
Figure 3. Renal Cell Carcinoma: Age-Adjusted Incidence Rates (AAIRs) Reported to NPCR and
SEER Registries, According to Histology
a
, Sex, and Race/Ethnicity, 2001-2018 .......................10
Figure 4. Renal Cell Carcinoma: Age-Specific Incidence Rates (ASIRs) Reported to NPCR and
SEER Registries, According to Sex, Race/Ethnicity and 5-Year Age Groups at Diagnosis, 2001-
2018.............................…………………………………………………………………………...11
Figure 5. Renal Cell Carcinoma: Age-Specific Incidence Rates (ASIRs) Reported to NPCR and
SEER Registries
a
, According to Histology, Sex, Race/Ethnicity, and 5-Year Age Groups at
Diagnosis, 2001-2018 …………………………………………………………………………...12
Figure 6. Renal Cell Carcinoma: Age-Adjusted Incidence Rates (AAIRs) Reported to NPCR and
SEER Registries
a
, Split by Age at Diagnosis [(00-69) and (70+)], According to Histology, Sex,
Race/Ethnicity, and Year of Diagnosis, 2001-2018 ......................................................................13
Figure 7. Renal Cell Carcinoma: Age-Adjusted Incidence Rates (AAIRs) Reported to NPCR and
SEER Registries
a
, According to Histology, Sex, and Laterality, and Year of Diagnosis, 2001-
2018.……………………………………………………………………………………………...15
Figure 8. Renal Cell Carcinoma: Age-Adjusted Incidence Rates (AAIRs) Reported to SEER18
Registries
a
, According to Histology, Sex, Race/Ethnicity, Stage at Diagnosis
b
, and Laterality of
Occurrence (2000-2018). ……………………………………………………………………..…17

vi
Figure 9. Renal Cell Carcinoma: Age-Standardized Absolute and Relative Survival (%)
Reported to SEER18 Registries, According to Sex,and Race/Ethnicity, 2000-2018 …...………19
Figure 10. Renal Cell Carcinoma: Age-Standardized Absolute and Relative Survival (%)
Reported to SEER18 Registries, According to Histology, Sex, and Race/Ethnicity, 2000-
2018………………………………………………………………………………………………20
Figure 11. Renal Cell Carcinoma: Age-Standardized Absolute and Relative Survival (%)
Reported to SEER18 Registries
a
, According to Histology, Sex, Race/Ethnicity, and Laterality
b

(2000-2018) ……………………………………………………………………………………..22
Figure 12. Clear Cell Renal Cell Carcinoma: Age-Standardized Absolute and Relative Survival
(%) Reported to SEER18 Registries
a
, According to Histology, Sex, Race/Ethnicity and Derived
AJCC 6
th
Edition Stage Group, 2004-2015 ……………………………………………………..24
Figure 13. Papillary Renal Cell Carcinoma: Age-Standardized Absolute and Relative Survival
(%) Reported to SEER18 Registries
a
, According to Histology, Sex, Race/Ethnicity and Derived
AJCC 6
th
Edition Stage Group, 2004-2015 ……………………………………………………..25
Figure 14. Chromophobe Renal Cell Carcinoma: Age-Standardized Absolute and Relative
Survival (%) Reported to SEER18 Registries
a
, According to Histology, Sex, Race/Ethnicity and
Derived AJCC 6
th
Edition Stage Group, 2004-2015 ……………………………………………26

vii
Abstract
Background: Renal cell carcinoma (RCC), the most common type of kidney cancer, is one of
the top contributing diagnoses of cancer in the United States (US). Treatment and care for older
patients and patients with advanced stage and metastatic tumors are an economic burden.
Information on incident cases and survival outcomes may create opportunities for better
diagnoses and prognoses of RCC.
Objective: To investigate histology-, sex-, racial/ethnic-, laterality-, and stage-specific
incidence; survival rates; and trends of RCC patients in the United States.
Methods: Age-adjusted and age-specific incidence rates (AAIRs) and age-standardized absolute
and relative survival rates were estimated using the Surveillance, Epidemiology, and End Results
(SEER) and National Program of Cancer Registries (NPCR) combined database (2001-2018) and
SEER18 (2000-2018) database for all RCC patients. Analyses were conducted over all RCC and
by three histologic types: clear cell, papillary, and chromophobe. The Ederer II method was used
to conduct survival analyses.
Results: The ratio of average AAIR between 2001 and 2018 for men and women was 2:1
overall, and for clear cell and papillary types. Chromophobe type showed no significant
difference in average AAIR between males and females. Incidence varied greatly by racial/ethnic
group, and differently in each cell type of RCC. Five-year absolute and relative survival rates
were similar between men and women, but varied by racial/ethnic group and stage at diagnosis.
Discussion: Future research should further evaluate the possibilities of incidence and survival
differences based on stage at diagnosis. Incidence of disease is increasing for all cell types in all
groups. However, the question of why certain populations are diagnosed at higher rates with one
histology versus another remains.

1
Chapter One: Introduction
Global urologic cancer burden (including kidney, prostate, and bladder) has been steadily
increasing in recent years, growing 2.5 fold between 1990 and 2013 (Dy et al, 2016), and
increases in newly diagnosed kidney cancer have been particularly noteworthy. Urologic cancers
heavily impact men from developed countries. Renal cell carcinoma (RCC), the most common
type of kidney cancer, is a numerically important form of cancer in the United States (US),
where incident RCC is nearly twice as common among men than among women. In 2022, there
will be an estimated 79,000 new cases of kidney cancer, including both kidney and renal pelvis
tumors, with 50,290 estimated cases in men and 28,710 in women (Cancer.org). These cases will
make up 4.1% of all incident cancer cases in the US. Moreover, because RCC tends to be
diagnosed later in life, between 64 and 75 years of age, even if age-specific rates were not
increasing, occurrence would rise in the United States as the disproportionately large ‘baby
boom’ population passes through ages at greatest risk. Elsewhere similar increases might result
from the more widespread demographic transition underway. One study reported that the annual
estimates of the cost of RCC in the US in 2009 value ranged between $0.60 to $5.19 billion
USD, and per-patient costs ranged between $16,488 and $43,805 USD (Shih et al, 2011).
Furthermore, costs of RCC treatment are highest among older patients who have advanced
stage/malignant tumors. Both the high cost of cancer care and treatment for RCC patients and the
considerable burden of RCC morbidity and mortality be exacerbated by increasing incidence.
Research that may identify new opportunities for primary, secondary and tertiary prevention is
therefore warranted.
Three major subtypes of RCC have been identified: clear cell, papillary, and
chromophobe. Clear cell (ccRCC) is the most commonly occurring histology, accounting for

2
approximately 70% of all cases, followed by papillary (pRCC) (10%) and chromophobe
(chRCC) (5%). Numerous studies of clinical series of patients documented a preponderance of
diagnoses among men compared to women and considerable differences in survival between
these cell types and within cell type according to stage at diagnosis and laterality of the primary
site. A prognostic factor of particular interest is tumor stage at diagnosis, specifically by tumor
node metastasis (TNM) staging. Several changes have been made to the American Joint
Committee on Cancer (AJCC) staging guidelines in the past two decades, reflecting potential
changes in clinical diagnosis of tumors, and thus, disease prognosis and outcome. TNM staging
may provide salient information on whether there are sex- and racial/ethnic-specific differences
in diagnosis, and how that may influence overall cancer risk and access to care in different
populations. The more recently reported clinical series may use more recent guidelines. Because
inferences that can be drawn from clinical series are limited by unknown patterns of referral for
care, population-based studies of RCC outcomes are still needed to assure external validity of
studies of RCC outcomes.
Previous population-based studies of RCC occurrence and outcomes conducted in the
United States (US) provided mostly descriptive summaries of data compiled by the Surveillance,
Epidemiology and End Results (SEER) network of cancer registries. For example, using
SEER18 data (2001-2016), Palumbo et al (2021) recently reported disparities in both age-
adjusted incidence and cancer-specific survival according to several demographic factors. Male
incidence was 15.5 per 100,000 person-years compared to female incidence at 7.7 per 100,000
person-years. The highest incidence (14.1/100 000 person years) and lowest 5-year cancer-
specific survival (80.1%) rates were found in non-Hispanic American Indian and Alaska Native
populations, among whom average annual (per calendar year) percent increase in incidence was

3
estimated to be 2.8%. These sex- and race/ethnicity-specific differences, along with increasing
temporal trends in AAIRs underscore the need to more extensively characterize patterns of RCC
occurrence and outcomes in order to refine hypotheses and future research pertaining to genetic
and environmental determinants of RCC risk as well as to biological and social determinants of
outcome.
SEER data represent approximately 30% of the US population and afford only limited
opportunities to conduct statistically meaningful analyses within relevant subgroups of RCC
patients and tumors. The database of SEER data combined with the National Program of Cancer
Registries (NPCR) was therefore used in this thesis to conduct more detailed statistical analyses
of incident RCC diagnosed throughout the US. This more extensive data resource allowed
exploration of potential differences in incidence between and among the RCC subtypes
according to sex, race, laterality of occurrence and tumor stage at diagnosis. Limiting analyses to
data from years 2000 forward allowed analyses of race and ethnicity jointly, a degree of detail
not available in the earlier SEER data. Unfortunately the NPCR and SEER resource does not
include detailed survival data. The SEER18 database was therefore used, that included TNM
stage at diagnosis as a covariate, to explore survival outcomes in comparable detail albeit in a
much smaller base population. Analyses addressed the hypothesis that incidence and survival
differ according to sex, as well as race and ethnicity. These differences may be more pronounced
in analyses according to other covariates of interest, such as laterality of occurrence, age at
diagnosis, and stage at diagnosis.
Thus, to address the need for descriptive epidemiologic studies of RCC, these population-
based descriptive epidemiologic data available from multiple complementary sources in the US
were used to characterize occurrence and outcomes of RCC between 2000 and 2018 in

4
previously unexplored detail. The analyses addressed temporal patterns of occurrence, numerous
demographic characteristics of affected individuals and their source populations, and multiple
clinical and anatomic features of RCC diagnosed in this period.

5
Chapter Two: Methods
Statistical Analysis
Following the established National Cancer Institute (NCI) protocols, population-based data
available from the year 2000 to 2018 were accessed from each of three cancer registry networks.
From the NPCR and SEER combined database, which covers over 99% of the population of the
United States (US), data collected from diagnosis years 2001-2018 (Released June 2021, Rate
Session) were used to describe occurrence of renal tumors (ICD-O-3 site code C64.9) in the
recent population-based data resource most representative of the US. Data were not included for
reports in which there were less than 16 available cases. This will be referred to as “suppression”
or “suppressed data” from here on out. From SEER21, the largest available set of population-
based US cancer incidence data for which suppression rules do not preclude detailed subgroup
analyses, data from diagnosis years 2000-2018 (Released April 2021, Rate Session) were used to
describe occurrence according to detailed demographic and tumor features. From SEER18, the
largest available population-based US cancer incidence data providing survival and mortality
data, information from diagnosis years 2000-2018 (Released April 2021, Survival Session) were
used to describe renal cell carcinoma outcomes. SEER*Stat software (Surveillance Research
Program, National Cancer Institute SEER*Stat software, version 8.4.0) was used to capture data
from all three population-based cancer data resources.
Incidence data
From each of the three cancer registry resources, age-adjusted (year 2000 US Standard
Population; <1 year and subsequent 5-year age groups to ≥85) incidence of kidney tumors (ICD-
O-3 site code C64.9), were captured overall, and according to sex (male, female) and
race/ethnicity (SEER 21: Non-Hispanic [NH] White, NH Black, NH Asian or Pacific Islander

6
[A/PI], NH American Indian/Alaska Native [AI/AN], Hispanic [H] (all races); NPCR and SEER:
Non-Spanish-Hispanic-Latino [NH] into Race recode variable (White [W], Black [B],
Asian/Pacific Islander [A/PI], American Indian/Alaska Native [AI/AN]) and Spanish-Hispanic-
Latino [H], all races). Tumors that arose in the renal pelvis (ICD-O-3 site code C65.9) were
specifically excluded from analyses.
From NPCR and SEER, age-specific incidence rates (ASIRs) (<1 year and subsequent 5-year
age groups to ≥85) were captured overall and according to cell type (malignant histology codes
8260/3 = papillary adenocarcinoma, 8310/3 = renal clear cell adenocarcinoma, 8317/3 = renal
cell adenocarcinoma, chromophobe type). Age-adjusted and age-specific rates were displayed
using line graphs created using Statistical Analysis System (SAS) 9.4 software. For each of the
three most common RCC tumor types, results were displayed for groups for which available data
supported this analysis as age-adjusted incidence by year of diagnosis and tested for significance
of trends by Joinpoint regression analysis.
Survival outcome data
From SEER18, additional information was extracted to estimate both absolute and relative
survival of patients diagnosed with RCC. One-year survival data were available for patients
diagnosed in the period 2000-2017, while 5-year survival data were available only for those
diagnosed 2000-2013. Point and 95% confidence interval (CI) estimates of 1- and 5-year
absolute and relative survival were estimated using the actuarial method with cumulative
expected values calculated by the Ederer II method, implemented in SEER*Stat software.
Expected survival rates for patients under observation at each point of follow-up are calculated
so the matched individuals are considered to be at risk until the corresponding cancer patient dies
or is censored. These estimates were made for groups defined by sex and race/ethnicity overall

7
and within strata defined by cell type histology, by tumor laterality of occurrence, and by derived
AJCC TNM stage group, 6
th
edition (covering tumors diagnosed between 2004 and 2015). To
calculate age-standardized estimates of both absolute and relative survival, the International
Cancer Survival Standard 1 (Ages 15+) was used as the standard population, with the age
variable as Age Standard for Survival (15-44, 45-54, 55-64, 65-74, 75+). The results of these
estimates within strata defined by sex, race/ethnicity, and RCC cell type are displayed as line
graphs. Tables of survival estimates are included in the supplementary materials.

8
Chapter Three: Results
Incidence
From 2001 to 2018 the NPCR and SEER Registry networks identified 916,591 incident
cases of the three major cell types of RCC. Over this period, age-adjusted incidence rates
steadily increased overall and within each histology, and also in both males and females (Figure
1). Average overall RCC AAIRs were 20.6 per 100,000 person-years for males and 10.6 per
100,000 person-years for females, and AAIRs increased from 17.2 to 21.9 per 100,000 for males
and 8.7 to 11.1 per 100,000 for females. Zero-knot Joinpoint regression estimates of average
annual percent change (AAPC) in RCC were 1.34% among men and 1.28% among women. The
AAPC was highest for clear cell type RCC, at 7.46% for men and 7.45% for women (Table 1).
Figure 1. Renal Cell Carcinoma: Age-Adjusted Incidence Rates (AAIRs) Reported to NPCR
and SEER Registries, According to Histology, Sex, and Year of Diagnosis 2001-2018.
Males Females
By Histology

Table 1. Renal Cell Carcinoma: Zero-knot Joinpoint Regression Average Annual Percent
Change (AAPC, %), According to Histology and Sex (From AAIRs in NPCR + SEER Data,
2001-2018)
Males Females
All RCC 1.34 1.28
Clear Cell 7.46 7.45
Papillary 5.08 5.86
Chromophobe 3.92 5.71

9
Figure 2 displays age-adjusted rates of these RCC types together and individually
according to sex and race/ethnicity. Rates of all RCC and of the clear cell and papillary RCC
types were notably higher in males than in females (Figure 3). Rates of all RCC are highest in
the NHAI/AN group, closely followed by rates in NHB, then NHW/Hispanic (all races), while
those for NHA/PI are notably lower. For clear cell RCC, NHAI/AN men and women also had the
highest average AAIRs in all years. For papillary RCC, NHB had the highest average AAIRs in
both men and women. NPCR data for papillary RCC were not available for NHAI/AN men
between 2001 and 2012, and for women owing to reporting of fewer than 16 cases each year in
each sex. Finally, for chromophobe RCC, the highest average AAIRs were observed among
NHB men and women; data were suppressed for NHAI/AN men and women.
Figure 2. Renal Cell Carcinoma: Age-Adjusted Incidence Rates (AAIRs) Reported to NPCR
and SEER Registries, According to Histology, Sex, and Race/Ethnicity, 2001-2018
Males Females
All RCC

10
Figure 3. Renal Cell Carcinoma: Age-Adjusted Incidence Rates (AAIRs) Reported to NPCR
and SEER Registries, According to Histology
a
, Sex, and Race/Ethnicity, 2001-2018.
Males Females
Clear cell

Papillary

Chromophobe

a
Incidence reported on different y-axes for individual histologic types. Clear cell is scaled at
20 per 100,000 person-years; papillary at 10 per 100,000 person-years; and chromophobe at
1.5 per 100,000 person-years.

Age specific incidence of RCC are depicted separately for males and females in figure 4.
The top panel provides age-specific rates for all RCC combined and for each histologic type
separately, while the bottom panel provides rates for all types for each racial/ethnic group. For

11
all cell types and groups incidence is low until mid-adulthood, increases rapidly with age to peak
at 65-79 years, and decreases somewhat in older groups.
Figure 4. Renal Cell Carcinoma: Age-Specific Incidence Rates (ASIRs) Reported to NPCR
and SEER Registries, According to Sex, Race/Ethnicity and 5-Year Age Groups at Diagnosis,
2001-2018.
Males Females
All RCC by Histology

All RCC by Race/Ethnicity

Figure 5 provides age-specific incidence rates of each of the individual RCC types for
males and females in each of racial/ethnic groups examined. Clear cell and papillary RCC data
were suppressed for those younger than 15 years of age, and data for the chromophobe type were
suppressed for those younger than 20. Peak age at diagnosis was at 65-79 years for most RCC
types and racial/ethnic groups, although lower for the papillary type among NHB men, at 65-69

12
years, and higher for the chromophobe type in both men and women of all groups, at 75-79
years.
Figure 5. Renal Cell Carcinoma: Age-Specific Incidence Rates (ASIRs) Reported to NPCR
and SEER Registries
a
, According to Histology, Sex, Race/Ethnicity, and 5-Year Age Groups
at Diagnosis, 2001-2018.
Males Females
Clear Cell

Papillary

Chromophobe

Temporal trends of AAIRs within two strata defined by age at diagnosis, 00-69 years and
70+ years age groups were further examined. The cut point separating these groups was based on
the peak age group at diagnosis evident in figures 4 and 5. These stratified depictions show that
temporal increases in AAIR were more dramatic for diagnoses at older ages at diagnosis for each

13
RCC type and sex, although trends are less evident for all RCC types combined (Figure 6).
Results of a separate analysis in which strata were defined as 00-74 and 75+ (Supplementary
Figure 1) provide a similar impression.
Figure 6. Renal Cell Carcinoma: Age-Adjusted Incidence Rates (AAIRs) Reported to NPCR
and SEER Registries
a
, Split by Age at Diagnosis [(00-69) and (70+)], According to Histology,
Sex, Race/Ethnicity, and Year of Diagnosis, 2001-2018.

Males, 00-69 years Males, 70+ years
Females, 0-69
years
Females, 70+ years
All RCC

Clear Cell

Papillary

Chromophob
e

To evaluate whether the right or left kidney might experience greater risk of RCC,
incidence was estimated according to laterality. Given the noteworthy differences in type- and
sex-specific incidence and clear upward trends of incidence with age, further analyses were
conducted for laterality of occurrence by cell type, sex, and race/ethnicity. Laterality was defined

14
as “Right - origin of primary”, “Left – origin of primary”, and “All other”, which included
unspecified laterality (“Only one side – side unspecified”, “Bilateral, single primary”, “Paired
site: midline tumor”, and “Paired site, but no information concerning laterality”). In males,
higher average incidence was identified in the right kidney for all RCC combined (10.10/100,000
person-years, solid line, compared to 9.70/100,000 person-years in the left kidney, dotted line)
and for the clear cell type (4.26 vs 4.06; Figure 7). However, these differences were small in
magnitude, and not as evident among females.

15
Figure 7. Renal Cell Carcinoma: Age-Adjusted Incidence Rates (AAIRs) Reported to NPCR
and SEER Registries
a
, According to Histology, Sex, and Laterality, and Year of Diagnosis,
2001-2018.
Males Females
All RCC

Clear Cell

Papillary

Chromophobe

To investigate occurrence according to stage at diagnosis, age-adjusted incidence of all
RCC and of RCC of each type were captured according to sex, race/ethnicity, derived AJCC
stage group (6
th
edition, 2004-2015) and laterality of primary tumor (Figure 8). Stage I appeared

16
to show the strongest differences in laterality across all cell types and most racial/ethnic groups
for men. However, a large number of cases were marked as “Blank(s)” for TNM stage at
diagnosis, along with several cases described with unspecified laterality of occurrence.
Regardless of laterality, among tumors with stage scored, those of stage I were far more common
for each sex, race/ethnicity, and tumor type.

17
Figure 8. Renal Cell Carcinoma: Age-Adjusted Incidence Rates (AAIRs) Reported to
SEER18 Registries
a
, According to Histology, Sex, Race/Ethnicity, Stage at Diagnosis
b
, and
Laterality of Occurrence (2000-2018).
Males Females
All RCC

Clear Cell

Papillary

Chromophobe

a
Derived AJCC 6
th
Edition TNM Stage Group (2004-2015)

18
Survival
Survival analyses were conducted according to the Ederer II method in SEER*Stat using
SEER18 (2000-2018) data. A total of 116,735 cases were followed for survival. In Figure 8, age-
standardized absolute and relative survival curves across the 18 years after diagnosis are
displayed by histology and sex, and by race and ethnicity for each histology. The overall 5-year
absolute and relative survival was slightly lower for men (60.9%, 71.0%) compared to women
(65.3%, 73.0%). This was reflected across all three histology cell types. For example, absolute
and relative survival rates for clear cell RCC were 69.7% and 81.4% for men and 75.0% and
84.0% for women For both males and females, the relative order of survival rates by cell type in
decreasing order was chromophobe, followed by papillary and clear cell.
When survival for each cell type was stratified by race and ethnicity, relative survival
was the highest and most stable for NHW men for both papillary and chromophobe type.
NHAI/AN men experienced the lowest absolute and relative survival rates for clear cell type;
NHAI/AN women followed a similar pattern. Survival data for chromophobe type was
suppressed after the first year of follow-up for NHAI/AN men and after 9 years of follow-up for
NHAI/AN women. Survival data for papillary type was suppressed after 7 years of follow-up for
NHAI/AN men and after 5 years of follow-up for women.
NHB men and women experienced the lowest absolute survival rates compared to other
racial/ethnic groups for papillary type, and also the lowest absolute and relative survival rates
compared to other racial/ethnic groups for chromophobe type. Survival data were available for
NHB men through 16 years of follow-up for papillary type and 14 years for chromophobe type.
For NHB women, survival data were available through 16 years of follow-up for papillary type
and 15 years for chromophobe type.

19

20

21
A limited series of clinical studies have reported a preponderance of RCC deaths in
individuals whose RCC arose in the right kidney (e.g., Cindolo et al, 2005). Differences in
survival were examined by laterality of occurrence of RCC tumors, stratified by sex, histology,
and race/ethnicity (Figure 9). Although some survival differences by side were noted, these were
small in magnitude and not consistent between tumor types, sex, or race/ethnicity. For example,
in papillary type, for NHW men, both absolute and relative survival for left-side tumors were
higher compared to right-side tumors. In contrast, for the years of follow-up data available (6
years for right and 7 years for left tumors), NHAI/AN men had greater absolute and relative
survival rates on the right side compared to the left side for papillary type tumors. NHAI/AN
women showed greater absolute and relative survival for left-side tumors in clear cell RCC,
although survival data was truncated at 12 years of follow-up for right-side tumors and 16 years
for left-side tumors.

22

23
Because tumor stage is an important recognized predictor of survival, to better
understand the role of sex and race/ethnicity, survival of all RCC and each individual type were
examined within strata of stage at diagnosis, which covers cases diagnosed between 2004 and
2015. As expected, survival was poorest for tumors of each type diagnosed at Stage IV (Figure
10-12). Chromophobe type showed the highest absolute and relative survival rates across all
stages for both males and females, although Stage IV data were suppressed for all
races/ethnicities except NHW and Hispanic males and NHW and NHB females, due to limited
data available for follow-up. Survival curves differed noticeably between several groups. Among
men, for whom data were richer, non-Hispanic whites appeared to fare better than Blacks for
many tumor types and stages at diagnosis. However, interval estimates overlapped between
groups in most intervals following diagnosis, limiting discernment of disparities.

24

25

26

27
Given differences in survival rates by all previous variables, survival analyses by cell
type, sex, race/ethnicity, laterality of occurrence, and stage at diagnosis were further conducted.
This final analysis, presented in Supplementary Tables 2 and 3, showed much lower 1- and 5-
year absolute and relative survival rates among stage IV diagnoses, but did not show any strong
differences in survival rates between left and right side tumors.

28
Chapter Four: Discussion
Renal cell carcinoma remains one of the leading types of cancer in the United States. This
study is a comprehensive examination of incidence and survival rates of the three major
histologic cell types of RCC, clear cell, papillary, and chromophobe, further stratified by sex,
race/ethnicity, laterality of occurrence, and stage at diagnosis. These findings reinforce what was
previously understood in the literature, and also reveal new patterns that should prompt further
investigation. Results may provide valuable insights for etiologic investigation and inform efforts
toward timely diagnosis and more accurate prognosis for RCC patients, thereby improving
prevention, diagnosis and cancer care and treatment, and overall quality of life of those who
develop RCC.
From the NPCR and SEER Registries Database (Released June 2021), 916,591 incident
cases were identified among the three RCC histologic types. Reflective of previous publications,
average age-adjusted incidence rates were twice as high among men for all RCC (20.6/100,000
person-years), compared to women (10.6/100,000 person-years). The male to female case
incidence ratio of kidney cancer globally has been shown to be 2:1 regardless of age at diagnosis,
year of diagnosis, and region in the world (Scelo et al, 2017). This was mirrored in clear cell
RCC as well; average AAIR for males was 8.3 compared to 4.6 for females. For papillary RCC,
average AAIR for males was 2.5 compared to 0.7 for females, and for chromophobe RCC,
average AAIR for males was for 0.7 compared to 0.5 for females. Because clear cell RCC makes
up around 70% of total RCC incident cases, the overall ratio of average AAIR between men and
women parallels the clear cell RCC average AAIR ratio. These incidence statistics hint at
potential factors responsible for the sex disparity outside of common risks like tobacco smoking
and obesity.

29
Temporally, Joinpoint zero-knot regression analyses demonstrated average annual
percent changes of 1.34% among men and 1.28% among women between 2001 and 2018. The
consistent growth in annual incidence suggests that in general, RCC may be becoming more
common in the US population; there may also be changes in tumor imaging and detection
technology that have resulted in increased cases.
From the SEER18 Registries Database (Released April 2021), 116,735 cases were
identified for survival outcome follow-up among the three RCC histologic types. Survival
analyses showed that one- and five-year age-standardized absolute and relative survival rates for
all RCC were somewhat higher for women (1-year: 91.9%, 93.7%; 5-year: 76.2%, 85.6%) than
for men (1-year: 90.6%, 93.1%; 5-year: 71.5%, 83.6%). This was reflected across all three cell
types, except for chromophobe, where relative survival was much more comparable between
men and women (5-year: 97.1% vs 96.4%). Chromophobe RCC also saw the highest absolute
and relative survival rates out of all three cell types, while clear cell RCC had the lowest.
Analyses stratified by race and ethnicity revealed disparities in both incidence and
survival that had been formerly addressed. Overall, NHAI/AN populations experienced the
highest age-adjusted incidence rates and lowest age-standardized absolute and relative survival
rates. NHAI/AN men had an average AAIR of 26.5 per 100,000 person-years, while NHAI/AN
women had an average AAIR of 15.2. In addition, five-year relative survival rates for the
NHAI/AN group were the lowest out of all racial/ethnic groups, at 77.6% for men and 80.4% for
women. The NHAI/AN population experienced similar patterns for clear cell adenocarcinoma,
with an average AAIR of 12.9 for men and 7.8 for women. Clear cell RCC age-standardized
five-year relative survival rates were 75.7% for NHAI/AN men and 80.2% for women. For
papillary adenocarcinoma, AAIRs had previous been found to be significantly different between

30
Black and White patients in a clinical setting (Lipworth et al, 2016). This difference was
especially pronounced among Black men. Another paper that examined racial/ethnic differences
in SEER18 data produced similar results, and also found that incidence of papillary RCC was
increasing more rapidly for Black populations compared to White populations (Olshan et al,
2013). However, neither of these analyses differentiated between Hispanic and non-Hispanic
populations. These analyses, which coded non-Hispanic races and Hispanic, with all races,
separately, showed that the average AAIR for papillary RCC for NHB men was 6.4 per 100,000
person-years, compared to NHW (2.2), NHAI/AN (1.2), NHA/PI (0.8), and Hispanic (1.2) men.
Among women, NHB also had the highest average AAIR for papillary RCC, at 1.7 per 100,000
person-years, compared to 0.7 per 100,000 for women across all races and ethnicities. Overall
papillary RCC five-year relative survival is 87.7% for all men and 82.1% for NHB men, and
88.3% for all women and 87.0% for NHB women. In chromophobe RCC, NHB men and women
also experienced the highest incidence rates, although not as stark in contrast due the low rates of
this histology across both sexes and all racial/ethnic groups. Relative five-year survival rates did
not vary greatly by race/ethnicity, but absolute survival revealed that NHAI/AN women
experienced the lowest rate at 71.0%, compared to 86.4% for all women. While incidence was
mostly suppressed for NHAI/AN populations in CRCC, the relative order of racial/ethnic groups
was intriguingly identical for both males and females in pRCC and CRCC. In making these
observations, risk factors affecting different ethnic groups should be accounted for, including
rates of obesity, differences in common diets, smoking behaviors, and other carcinogenic factors
may predispose populations unequally to certain types of RCC.
When taking into consideration tumor laterality of occurrence, results varied by sex and
race/ethnicity. In men, overall RCC tumor incidence was slightly higher across all years of

31
diagnosis on the right side than on the left. The average AAIR for right-side tumors in men was
10.10 per 100,000 person-years and for left-side tumors, 9.70 per 100,000 person years. This
difference was not as pronounced among women overall: average AAIR for right-side tumors
was 5.10 per 100,000 P-Ys compared to 5.09 per 100,000 person-years for left-side tumors.
When stratified by cell type, men showed the most obvious difference by laterality in clear cell
adenocarcinoma (Right: 4.26/100,000 P-Ys; Left: 4.02/100,000 P-Ys). Within clear cell,
NHAI/AN men had the largest difference in incidence rates between the two sides (Right:
6.77/100,000 P-Ys; Left: 5.98/100,000 P-Ys). One clinical series on chromophobe RCC
documenting patients at six European centers found that of the cases of chRCC identified, the
majority (55%) of tumors were located in the right kidney (Cindolo et al, 2005). They also
documented that of their 9 patients who died of cancer-specific disease, 8 had tumors in the right
kidney, and one had unknown laterality. However, the SEER chRCC data showed that at the
population level, differences in laterality by sex were not very different. Stratification by race
and ethnicity did not show any stronger differences. Papillary RCC followed similar patterns,
where average AAIR for males was 1.25 on the right and 1.21 on the left, and for females, 0.34
on the right and 0.35 on the left. In contrast, here, stratification by racial/ethnic group resulted in
slightly larger differences between the two sides for NHB (Right: 3.27/100,000 P-Ys; Left:
3.13/100,000 P-Ys) and NHAI/AN (Right: 0.62/100,000 P-Ys vs Left: 0.53/100,000 P-Ys) men,
compared to all other groups.
Lastly, TNM stage at diagnosis was considered in survival analyses. The earlier
hypothesis was that there may be differences in distribution of stage across sex, race/ethnicity,
and laterality. Results from SEER18 survival analyses showed that the differences in these data
are not based on the distribution of stage at diagnosis alone. There are still apparent differences

32
by racial/ethnic groups within stage at diagnosis. Although statistical analyses comparing
survival curves by each group were not conducted, from the data available in the figures, it is
clear that the most common TNM stage at diagnosis across all cell types, sexes, and racial/ethnic
groups is Stage I. In papillary RCC, NHB men had the worst absolute and relative survival
across Stages I through III compared to all other racial/ethnic groups of men. NHB men also
appeared to have the lowest survival rates in Stages III and IV for clear cell RCC. NHAI/AN
populations had suppressed data for clear cell type in Stages II, III and IV, but in Stage I, both
men and women had the lowest survival curves. In the supplementary tables, further survival
data is provided on laterality of occurrence by stage at diagnosis. While these data are rather
sparse, they invite questions as to how RCC tumors are being staged and recorded for laterality,
and if missingness of data are occurring together or separately for these two covariates. These
results provide hints that there is a need for changes in clinical care and in access to quality of
care. Considerations of etiology are essential in decreasing risk of disease and improving
outcomes.
This study was limited by the available data for analysis in the SEER database. While
NPCR and SEER are able to cover registries across the entirety of the United States, thereby
giving the most thorough and up to date information on incidence, SEER18 data were used to
conduct survival analyses due to its information on TNM stage at diagnosis. This limited the
number of cases that could be followed up on, compared to incidence analyses. Although SEER
sets the standard for tumor staging and laterality of occurrence, there were large degrees of
missing data on staging and laterality records, which could be potential sources of
misclassification and systematic biases. In addition, there is potential for misclassification of
patients’ race and ethnicity; whether it is self-identified or otherwise is unknown. Racial/ethnic

33
groups are broadly named, and may obscure patterns within each group that is made up of
diverse communities. Analyses also were not adjusted for known causes of renal cancer, such as
smoking behavior and obesity, as these data are not available through the NPCR and SEER
databases. Finally, data available in the NPCR and SEER resource provide little insight into
causes of the important temporal increases in RCC incidence.
Future research should aim to dig deeper into the possibilities of incidence and survival
differences based on stage at diagnosis. Incidence of disease is increasing for all cell types in all
groups. However, the question of why certain populations are diagnosed at higher rates with one
histology versus another remains. Do differences in genetic backgrounds predispose people to
different types of RCC? For survival, it is clear that stage I is the most common stage at
diagnosis for all cell types, sexes and racial/ethnic groups. More data needs to be assessed on
why survival may differ between these groups in each stage.

34
References
Cindolo, L., de La Taille, A., Schips, L., Zigeuner, R. E., Ficarra, V., Tostain, J., Artibani,
W., Gallo, A., Salzano, L., & Patard, J. J. (2005). Chromophobe renal cell carcinoma:
Comprehensive analysis of 104 cases from multicenter European database. Urology,
65(4), 681–686. https://doi.org/10.1016/J.UROLOGY.2004.11.005
Dy, G. W., Gore, J. L., Forouzanfar, M. H., Naghavi, M., & Fitzmaurice, C. (2017). Global
Burden of Urologic Cancers, 1990–2013 [Article]. European Urology, Vol. 71, pp. 437–
446. https://doi.org/10.1016/j.eururo.2016.10.008
Feng, X., Zhang, L., Tu, W., & Cang, S. (2019). Frequency, incidence and survival outcomes
of clear cell renal cell carcinoma in the United States from 1973 to 2014 A SEER-based
analysis [Article]. Medicine (United States), 98(31), e16684–e16684.
https://doi.org/10.1097/MD.0000000000016684
Li, X., & Thirumalai, D. (2021). Imprints of tumor mutation burden on chromosomes and
relation to cancer risk in humans: A pan-cancer analysis. BioRxiv, 2020.04.20.050989.
https://doi.org/10.1101/2020.04.20.050989
Lipworth, L., Morgans, A. K., Edwards, T. L., Barocas, D. A., Chang, S. S., Duke Herrell,
S., … Clark, P. E. (2016). Renal cell cancer histological subtype distribution differs by
race and sex [Article]. BJU International, 117(2), 260–265.
https://doi.org/10.1111/bju.12950
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Program SEER*Stat Database: NPCR and SEER Incidence - U.S. Cancer Statistics
Public Use Research Database, 2020 Submission (2001-2018). United States Department
of Health and Human Services, Centers for Disease Control and Prevention and National
Cancer Institute. Released June 2021. Accessed at www.cdc.gov/cancer/uscs/public-use.
Palumbo, C., Pecoraro, A., Knipper, S., Rosiello, G., Luzzago, S., Deuker, M., …
Karakiewicz, P. I. (2021). Contemporary Age-adjusted Incidence and Mortality Rates of
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Peired, A. J., Campi, R., Angelotti, M. L., Antonelli, G., Conte, C., Lazzeri, E., …
Romagnani, P. (2021). Sex and gender differences in kidney cancer: Clinical and
experimental evidence [Article]. Cancers, Vol. 13, p. 4588.
https://doi.org/10.3390/cancers13184588
Scelo, G., Li, P., Chanudet, E., & Muller, D. C. (2018). Variability of Sex Disparities in
Cancer Incidence over 30 Years: The Striking Case of Kidney Cancer [Article].
European Urology Focus, 4(4), 586–590. https://doi.org/10.1016/j.euf.2017.01.006

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Shih, Y. C. T., Chien, C. R., Xu, Y., Pan, I. W., Smith, G. L., & Buchholz, T. A. (2011).
Economic burden of renal cell carcinoma: Part I an updated review [Article].
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Strauss, A., Uhlig, J., Lotz, J., Trojan, L., & Uhlig, A. (2019). Tumor laterality in renal
cancer as a predictor of survival in large patient cohorts: A STROBE compliant study
[Article]. Medicine, 98(17), e15346. https://doi.org/10.1097/MD.0000000000015346
Surveillance, Epidemiology, and End Results (SEER) Program (www.seer.cancer.gov)
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Sub (2000-2018) - Linked To County Attributes - Total U.S., 1969-2019 Counties,
National Cancer Institute, DCCPS, Surveillance Research Program, released April 2021,
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(seer.cancer.gov/seerstat) version 8.4.0.
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36
APPENDICES
Appendix A. Supplementary Incidence Figures
Supplementary Figure 1. Kidney Tumors and Renal Cell Carcinomas: Age-Adjusted Incidence Rates
(AAIR); NPCR and SEER Registries
a
, 2001-2018; Age-Adjusted Rates According to Year of
Diagnsosis, By Sex, Race/Ethnicity, and Age at Diagnosis (00-74) and (75+)
Males, 00-74 years Males, 75+ years Females, 0-74 years Females, 75+ years
Clear cell

Papillary

Chromophob
e

a
National Program of Cancer Registries and Surveillance, Epidemiology and End Results Program
SEER*Stat Database: NPCR and SEER Incidence - U.S. Cancer Statistics Public Use Research
Database, 2020 Submission (2001-2018). United States Department of Health and Human Services,
Centers for Disease Control and Prevention and National Cancer Institute. Released June 2021.
Accessed at www.cdc.gov/cancer/uscs/public-use.

Supplementary Figure 2. All Renal Cell Carcinomas Age-Adjusted Incidence Rates (AAIR); NPCR
and SEER Registries
a
, 2001-2018; Age-Adjusted Rates by Sex, Race/Ethnicity
b
, and Laterality.
Males Females
NHW

37
NHB

NHAI/AN

NHA/PI

Hispanic

a
National Program of Cancer Registries and Surveillance, Epidemiology and End Results Program
SEER*Stat Database: NPCR and SEER Incidence - U.S. Cancer Statistics Public Use Research
Database, 2020 Submission (2001-2018). United States Department of Health and Human Services,
Centers for Disease Control and Prevention and National Cancer Institute. Released June 2021.
Accessed at www.cdc.gov/cancer/uscs/public-use.
b
NHW = Non-Hispanic White; NHB = Non-Hispanic Black; NHAI/AN = Non-Hispanic American
Indian/Alaska Native; NHA/PI = Non-Hispanic Asian or Pacific Islander; Hispanic = Hispanic, all
races.

38
Supplementary Figure 3. Clear Cell Renal Cell Carcinoma: Age-Adjusted Incidence Rates (AAIR);
NPCR and SEER Registries
a
, 2001-2018; Age-Adjusted Rates by Sex, Race/Ethnicity
b
, and Laterality.
Males Females
NHW

NHB

NHAI/AN

NHA/PI

39

Supplementary Figure 4. Papillary Renal Cell Carcinoma: Age-Adjusted Incidence Rates (AAIR);
NPCR and SEER Registries
a
, 2001-2018; Age-Adjusted Rates by Sex, Race/Ethnicity
b
, and Laterality.
Males Females
NHW

NHB

Hispanic

a
National Program of Cancer Registries and Surveillance, Epidemiology and End Results Program
SEER*Stat Database: NPCR and SEER Incidence - U.S. Cancer Statistics Public Use Research
Database, 2020 Submission (2001-2018). United States Department of Health and Human Services,
Centers for Disease Control and Prevention and National Cancer Institute. Released June 2021.
Accessed at www.cdc.gov/cancer/uscs/public-use.
b
NHW = Non-Hispanic White; NHB = Non-Hispanic Black; NHAI/AN = Non-Hispanic American
Indian/Alaska Native; NHA/PI = Non-Hispanic Asian or Pacific Islander; Hispanic = Hispanic, all
races.

40
NHAI/AN
Suppressed data Suppressed data
NHA/PI

Hispanic

a
National Program of Cancer Registries and Surveillance, Epidemiology and End Results Program
SEER*Stat Database: NPCR and SEER Incidence - U.S. Cancer Statistics Public Use Research
Database, 2020 Submission (2001-2018). United States Department of Health and Human Services,
Centers for Disease Control and Prevention and National Cancer Institute. Released June 2021.
Accessed at www.cdc.gov/cancer/uscs/public-use.
b
NHW = Non-Hispanic White; NHB = Non-Hispanic Black; NHAI/AN = Non-Hispanic American
Indian/Alaska Native; NHA/PI = Non-Hispanic Asian or Pacific Islander; Hispanic = Hispanic, all
races.

41
Supplementary Figure 5. Chromophobe Renal Cell Carcinoma: Age-Adjusted Incidence Rates
(AAIR); NPCR and SEER Registries
a
, 2001-2018; Age-Adjusted Rates by Sex, Race/Ethnicity
b
, and
Laterality.
Males Females
NHW

NHB

NHAI/AN
Suppressed data Suppressed data
NHA/PI

Hispanic

42

a
National Program of Cancer Registries and Surveillance, Epidemiology and End Results Program
SEER*Stat Database: NPCR and SEER Incidence - U.S. Cancer Statistics Public Use Research
Database, 2020 Submission (2001-2018). United States Department of Health and Human Services,
Centers for Disease Control and Prevention and National Cancer Institute. Released June 2021.
Accessed at www.cdc.gov/cancer/uscs/public-use.
b
NHW = Non-Hispanic White; NHB = Non-Hispanic Black; NHAI/AN = Non-Hispanic American
Indian/Alaska Native; NHA/PI = Non-Hispanic Asian or Pacific Islander; Hispanic = Hispanic, all
races.

Supplementary Figure 6. Clear Cell Renal Cell Carcinoma: Age-Specific Incidence Rates
(ASIR); NPCR and SEER Registries
a
, 2001-2018; Age-Specific Rates by Sex,
Race/Ethnicity
b
, and Laterality.
Males Females
NHW

NHB

NHAI/AN

43
NHA/PI

Hispanic

a
National Program of Cancer Registries and Surveillance, Epidemiology and End Results
Program SEER*Stat Database: NPCR and SEER Incidence - U.S. Cancer Statistics Public Use
Research Database, 2020 Submission (2001-2018). United States Department of Health and
Human Services, Centers for Disease Control and Prevention and National Cancer Institute.
Released June 2021. Accessed at www.cdc.gov/cancer/uscs/public-use.
b
NHW = Non-Hispanic White; NHB = Non-Hispanic Black; NHAI/AN = Non-Hispanic
American Indian/Alaska Native; NHA/PI = Non-Hispanic Asian or Pacific Islander; Hispanic
= Hispanic, all races.

44
Supplementary Figure 7. Papillary Renal Cell Carcinoma: Age-Specific Incidence Rates (ASIR);
NPCR and SEER Registries
a
, 2001-2018; Age-Specific Rates by Sex, Race/Ethnicity
b
, and Laterality.
Males Females
NHW

NHB

NHAI/AN

Suppressed data
NHA/PI

45
Hispanic

a
National Program of Cancer Registries and Surveillance, Epidemiology and End Results Program
SEER*Stat Database: NPCR and SEER Incidence - U.S. Cancer Statistics Public Use Research
Database, 2020 Submission (2001-2018). United States Department of Health and Human Services,
Centers for Disease Control and Prevention and National Cancer Institute. Released June 2021.
Accessed at www.cdc.gov/cancer/uscs/public-use.
b
NHW = Non-Hispanic White; NHB = Non-Hispanic Black; NHAI/AN = Non-Hispanic American
Indian/Alaska Native; NHA/PI = Non-Hispanic Asian or Pacific Islander; Hispanic = Hispanic, all
races.

Supplementary Figure 8. Chromophobe Renal Cell Carcinoma: Age-Specific Incidence Rates
(ASIR); NPCR and SEER Registries
a
, 2001-2018; Age-Specific Rates by Sex, Race/Ethnicity
b
, and
Laterality.
Males Females
NHW

NHB

46
NHAI/AN
Suppressed data Suppressed data
NHA/PI

Hispanic

a
National Program of Cancer Registries and Surveillance, Epidemiology and End Results Program
SEER*Stat Database: NPCR and SEER Incidence - U.S. Cancer Statistics Public Use Research
Database, 2020 Submission (2001-2018). United States Department of Health and Human Services,
Centers for Disease Control and Prevention and National Cancer Institute. Released June 2021.
Accessed at www.cdc.gov/cancer/uscs/public-use.
b
NHW = Non-Hispanic White; NHB = Non-Hispanic Black; NHAI/AN = Non-Hispanic American
Indian/Alaska Native; NHA/PI = Non-Hispanic Asian or Pacific Islander; Hispanic = Hispanic, all
races.

47

Appendix B. Supplementary Survival Tables

48

49

50

51

52

53

54

55

56

57

58

59

60

61

Abstract (if available)

Abstract Full title: Incidence and survival rates of the three major histologies of renal cell carcinoma: a descriptive epidemiologic analysis by sex, race/ethnicity, laterality of occurrence and stage at diagnosis using SEER data/ Background: Renal cell carcinoma (RCC), the most common type of kidney cancer, is one of the top contributing diagnoses of cancer in the United States (US). Treatment and care for older patients and patients with advanced stage and metastatic tumors are an economic burden. Information on incident cases and survival outcomes may create opportunities for better diagnoses and prognoses of RCC.
Objective: To investigate histology-, sex-, racial/ethnic-, laterality-, and stage-specific incidence; survival rates; and trends of RCC patients in the United States.
Methods: Age-adjusted and age-specific incidence rates (AAIRs) and age-standardized absolute and relative survival rates were estimated using the Surveillance, Epidemiology, and End Results (SEER) and National Program of Cancer Registries (NPCR) combined database (2001-2018) and SEER18 (2000-2018) database for all RCC patients. Analyses were conducted over all RCC and by three histologic types: clear cell, papillary, and chromophobe. The Ederer II method was used to conduct survival analyses.
Results: The ratio of average AAIR between 2001 and 2018 for men and women was 2:1 overall, and for clear cell and papillary types. Chromophobe type showed no significant difference in average AAIR between males and females. Incidence varied greatly by racial/ethnic group, and differently in each cell type of RCC. Five-year absolute and relative survival rates were similar between men and women, but varied by racial/ethnic group and stage at diagnosis.
Discussion: Future research should further evaluate the possibilities of incidence and survival differences based on stage at diagnosis. Incidence of disease is increasing for all cell types in all groups. However, the question of why certain populations are diagnosed at higher rates with one histology versus another remains.

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Creator Bai, Claire (author)

Core Title Incidence and survival rates of the three major histologies of renal cell carcinoma

School Keck School of Medicine

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Degree Conferral Date 2022-08

Publication Date 07/22/2022

Defense Date 07/22/2022

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