Race affects access to nephrectomy but not survival in renal cell carcinoma

To assess whether, in contemporary patients with renal cell carcinoma (RCC), access to nephrectomy is the same between the Blacks and Whites, and that there is no difference in mortality after stratification for treatment type.

The effect of race has received little attention in RCC; only two reports have addressed and suggested the presence of racial disparities, including access to nephrectomy and survival after nephrectomy, where Black patients were disadvantaged relative to Whites. We used the Surveillance, Epidemiology and End Results data from 12 516 patients of all stages diagnosed and treated for RCC between 2000 and 2004. The effect of race (Black vs White) on nephrectomy rate was addressed in logistic regression and binomial regression models, and Cox regression models tested the effect of race on overall survival.

Black patients were 50% less likely to have a nephrectomy than their White counterparts. However, race had no effect on overall survival when the entire cohort was assessed, as well as in subgroups of patients with or without nephrectomy.

Although race is a determinant of access to nephrectomy, it should not be interpreted as a barrier to care, as survival was unaffected by race in patients having a nephrectomy or not. Instead, race might represent a proxy of comorbidity and life-expectancy, which represent surgical selection criteria for nephrectomy.