Predictors of Survival and Recurrence After Partial or Radical Nephrectomy in Women with Localized Renal Cell...

Renal cell carcinoma (RCC) is marked by significant gender differences in incidence. While RCC is more common in men, limited data exist on survival outcomes in women following surgery. We investigated survival outcomes and predictive factors in women with localized RCC.

We conducted a retrospective multicenter analysis of women who underwent surgery for Stage I-III RCC. Primary outcome was recurrence. Multivariable Cox regression assessed predictors of All-Cause Mortality (ACM), Cancer-Specific Mortality (CSM), and recurrence. Kaplan-Meier analysis (KMA) evaluated overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS) across racial/ethnic groups.

We analyzed 3218 women (median age 61 years; follow-up 63 months), with 454 (14.1%) experiencing recurrence. On multivariable analysis, high Charlson score (HR 1.89, P < .001), AJCC stage II/III (HR 2.44, P < .001), high-grade (HR 2.24, P < .001), and positive margins (HR 2.02, P < .001) were associated with recurrence. Black race (HR 0.68, P = .046) and chromophobe histology (HR 0.32, P = .002) were protective. For ACM, increasing age (HR 1.04, P < .001), High/Intermediate Charlson score (HR 1.52, HR 1.34: P = .006, P < .001), AJCC stage II/III (HR 1.46, P < .001), high-grade (HR 1.51, P < .001), GFR <45 (HR 1.63, P < .001), recurrence (HR 1.45, P < .001) were predictive, while Asian (HR 0.40, P < .001) and Hispanic (HR 0.53, P = .048) race were protective. CSM was associated with age (HR 1.04, P < .001), AJCC stage II/III (HR 2.06, P = .006), high-grade (HR 1.62, P < .001), and recurrence (HR 5.38, P < .001); Asian race (HR 0.52, P < .001) was protective. KMA showed significant differences in OS and CSS (P < .001), but not RFS (P = .136).

In addition to known clinico-pathologic predictors, ethno-racial differences were noted in survival and recurrence among women with RCC. Recurrence was a major determinant of mortality. Black women had lower recurrence risk, while Asian and Hispanic women had improved survival. These findings highlight the influence of systemic disparities beyond tumor biology.