Has Stage Migration in Renal Cancer Run Its Course? A SEER Database Analysis

Both population-based databases and institutional cohorts demonstrated downward stage migration in renal cancer incidence, paralleling an increased use of cross-sectional imaging. More than 3 decades have passed since the introduction of cross-sectional imaging. Therefore, the trend toward lower stage renal cancer may have reached its full potential. We aimed to examine renal cancer incidence, survival, and mortality trends.

Examining the Surveillance, Epidemiology, and End Results (SEER) database, data on renal cancer patients older than 20 years were extracted. We calculated age-adjusted incidence, mortality rates, and 5-year cancer-specific survival between 2000 and 2016. Trends were quantified with the annual percentage change (APC) and analyzed by joinpoint analysis according to disease stage.

The incidence APC of localized, regional, and distant stage was +2.7% per year, +0.6% per year, and -0.4% per year, respectively. There was a significant decrease in APC for localized disease in 2008. The APC in 5-year cancer-specific survival rates of localized, regional, and distant disease were 0.28%, 1.03%, year and 0.43% per year, respectively, with no joinpoint identified. The overall age-adjusted mortality increased by 5.8% per year. For localized disease, mortality APC sequentially decreased from 80.1% per year before 2002 to 15.9% per year between 2002 and 2009, and to 6% per year after 2009. The mortality APC of regional and distant disease changed in 2002 from 74.2% per year to 3.8% per year, and from 31.1% per year to -0.3% per year (P < .001 for both), respectively.

The upward trend of renal cancer incidence has been curbed, probably as a result of the use of cross-sectional imaging reaching its potential as a pseudo-screening tool. Localized disease mortality rates continued to increase at a decreasing rate.