Renal cell carcinoma survival in the immunotherapy era: A comprehensive analysis of healthcare and socioeconomic inequalities.

Abstract

e16528 Background: Use of immunotherapy after surgery and in the metastatic setting has significantly improved overall survival (OS) in patients with renal cell carcinoma (RCC). Checkmate 214 demonstrated nivolumab plus ipilimumab outperformed sunitinib, with an 18-month OS rate of 75% versus 60% for sunitinib. Using the National Cancer Data Base (NCDB), this study evaluates survival trends in the immunotherapy era (IE) versus the pre-immunotherapy era (PIE) focusing on identifying inequities in care and difference in outcomes. Methods: In this retrospective cohort study, we examined NCDB involving stage III-IV RCC diagnosed between the years 2006-2021. Patients were classified as being treated in the PIE (2010-2015) or the IE (2016-2020). Differences in OS between eras and relevant characteristics within the IE were compared using Kaplan-Meier method and tested using log rank test. Comparisons were made for patients diagnosed in stage III-IV combined and separately. Survival disparities across healthcare settings, socioeconomic strata, and racial subgroups. Results: Data from 140,468 RCC patients demonstrated significant survival improvements in stages III-IV during the IE compared to the PIE (p < 0.001). Survival outcomes were notably higher among privately insured patients, those treated at academic centers, and individuals with higher incomes (p < 0.001). Despite these gains, racial disparities persisted, with Hispanic patients showing superior OS (p < 0.001). Cox regression analysis indicated that immunotherapy was associated with reduced mortality risk (HR = 0.76, p < 0.001). Protective factors included treatment at academic centers (HR = 0.82, p < 0.001), residing in urban settings (HR = 0.93, p < 0.001), and higher income levels (HR = 0.84, p < 0.001). The table below presents median survival and 5-year OS across all variables. Conclusions: Immunotherapy significantly improves OS in later stage RCC. Improved outcomes are apparent in the privately insured, higher socioeconomic status and those treated at academic centers. Racial disparities are prevalent and require further investigation. These findings highlight the need to address socioeconomic and racial disparities, as well as to broaden access to therapy to enhance survival outcomes for all RCC patients. Category Subgroup N Median Survival (Months) 5 yr OS (%) P-Value Stage III, IV IE 71,545 45.54 45 <0.001 PIE 68,917 27.07 37 Race Hispanic 6,119 67.02 52 <0.001 Asian/Pacific Islander 2,198 65.87 52 Non-Hispanic Black 6,289 27.33 38 Non-Hispanic White 55,137 45.14 44 Insurance Medicaid 5,228 40.38 43 <0.001 Medicare 37,087 32.76 38 Not Insured 2,104 37.19 42 Other Government 1,165 41.99 44 Private 25,130 75.73 55 Facility Non-Academic 40,040 35.09 40 <0.001 Academic 29,930 59.30 50 Income < $46,277 10,741 36.80 41 <0.001 $46,277-$57,856 14,028 40.51 42 $57,857 - $74,062 14,838 43.79 44 $74,063 + 20,863 54.93 48