Impact of gender in renal cell carcinoma: an analysis of the SEER database

To evaluate gender differences in initial presentation, pathology, and outcomes with renal cell carcinoma (RCC).

The 1973-2004 Surveillance Epidemiology and End Results (SEER) 17-registries database was analyzed for renal tumors from 1988 to 2004 coded as primary site "kidney and renal pelvis." After various exclusions, a final study group of 35,336 cases with complete data was obtained. Demographic variables analyzed included age, sex, and race. Tumor variables included size, stage at diagnosis, grade, and histology. Primary outcome variables included overall and cancer-specific survival.

Of the patients, 22,288 were male (63%). Females presented with smaller tumors (5.9 vs. 6.1cm, p<0.0001) of lower grade (p<0.0001). Males had a higher incidence of regional or metastatic spread of renal carcinoma (p<0.0001). Median overall survival from time of diagnosis was 130 mo for females versus 110 mo for males (p<0.0001). In comparisons of males and females, 5-yr cancer-specific survival was 78% versus 81%, and 5-yr overall survival was 65% versus 69% (p<0.0001). On multivariate analysis, cancer-specific survival was similar (HR, 1.00, p=0.960), whereas overall survival was significantly longer for females (HR, 0.92, p<0.0001). Older age at diagnosis, larger tumor size, higher grade, higher SEER historic stage, and sarcomatoid, collecting duct, or "other" histology were related to worse cancer-specific and overall survival.

Men present with larger, higher stage, higher grade RCC than women. Overall survival is better in women, whereas cancer-specific survival is not significantly different.