Renal Cell Carcinoma: Prognosis in the Era of Targeted Therapy

Background: Significant changes in renal cell carcinoma (RCC) drug treatment and improved access to abdominal imaging have recently been implemented. The impact of these changes on patient characteristics and prognosis remains to be quantified. Methods: A population-based cohort of 210,418 RCC cases from the Centre for Cancer Registry Data (ZfKD) diagnosed in Germany between 2000 and 2019 was analyzed in this observational study. Three time periods of diagnosis were defined, the first (2000-2005) functioning as a control. The remaining were defined according to the introduction of tyrosine kinase targeting drugs (2006-2014) and checkpoint inhibitor drugs (2015-2019). Five-year relative survival (RS) trends for each risk group and metastatic RCC (mRCC) were determined using Poisson regression models. Results: Age at diagnosis and the proportion of low-risk disease increased, while the proportion of mRCC decreased (p < 0.0001). RS improved slightly between the first and last period in low (5-year RS 98.7% vs. 100.9%), intermediate (89.2% vs. 91.9%), and high-risk (76.6% vs. 80.3%), as well as mRCC (28.3% vs. 29.1%). The overall change in prognosis was significant in low (p = 0.0233) and high-risk groups (p = 0.0002), but not in intermediate-risk and mRCC groups. In a multivariate analysis, high-risk ccRCC patients appear to profit from drug treatment advances. Conclusions: Earlier detection has improved prognosis for the majority of RCC patients. Further efforts should be aimed at diagnosing more mRCC patients earlier, when surgical tumor removal remains feasible.