A stage-for-stage and grade-for-grade analysis of cancer-specific mortality rates in renal cell carcinoma according to age: a competing-risks regression analysis

Abstract

Background: The association of advanced age and cancer control outcomes shows discordant findings.

Objective: To evaluate the effect of age on cancer control outcomes in a large population-based cohort of patients diagnosed with renal cell carcinoma (RCC) of all stages.

Design, setting, and participants: Using the Surveillance Epidemiology and End Results database, 36 333 patients with RCC were identified. The population was stratified according to age:<50, 50-59, 60-69, 70-79, and ≥80 yr. The effect of age on cancer control outcomes was evaluated using competing-risks regression models. Analyses were repeated stage for stage and grade for grade.

Measurements: Cancer-specific mortality (CSM) was measured.

Results and limitations: Age categories 50-59, 60-69, 70-79, and ≥80 yr respectively portended a 1.4-, 1.5-, 1.6-, and 1.9-fold higher risk of CSM than age category <50 yr (all p < 0.001). The effect of advanced age was particularly detrimental in patients with stage I disease: 1.8-, 2.3-, 3.2-, and 3.8-fold higher CSM risk for the same age groups, respectively (all p<0.001). The effect of age on CSM was at its peak in patients with stage I, low-grade RCC (1.6-, 2.2-, 3.6-, and 4.3-fold, respectively; all p<0.001) and remained elevated in stage I, high-grade RCC (2.2-, 2.6-, 2.4-, and 3.0-fold higher, respectively; all p<0.05). Conversely, its effect was virtually absent in patients with stage II-IV RCC.

Conclusions: Our data suggest that stage I RCC may behave in a more aggressive fashion in elderly patients. Further studies are required to confirm the current findings.