Regional Differences in the Clinical Presentation of Registry-Recorded Renal Cell Carcinoma and Area-Level Healthcare...

Background/Objectives: Healthcare resources are unevenly distributed across Miyazaki Prefecture, Japan. We examined regional differences in the clinical presentation of renal cell carcinoma (RCC) recorded in the Miyazaki Urological Cancer Database (MUCD), together with area-level healthcare resource indicators. Methods: We performed a retrospective descriptive observational analysis of prospectively collected data from the multicenter MUCD registry. After deduplication and rechecking eligibility, 540 patients with a documented diagnosis date within the study period (1 April 2019-31 March 2024) were included (Central/Southern, n = 333; Western, n = 116; Northern, n = 91). The three main clinical outcomes were adjusted for age and sex, with clustering by registering facility taken into account. Results: Presentation with predefined local symptoms occurred in 18.6%, 19.0%, and 34.1% of patients in the Central/Southern, Western, and Northern areas, respectively. Compared with Central/Southern, the adjusted odds ratio for predefined local symptoms in the Northern area was 2.30 (95% CI, 1.39-3.81). Median tumor size was 3.8, 4.4, and 5.0 cm, respectively; the adjusted mean difference for Northern versus Central/Southern was 1.24 cm (95% CI, 0.65-1.82). Clinical M1 disease was recorded in 10.2%, 12.1%, and 19.8%, respectively; the global test accounting for facility clustering yielded p = 0.076, and the Holm-adjusted p value for Northern versus Central/Southern was 0.082. Urologist density in 2024 was 8.7, 8.0, and 5.3 per 100,000 population, respectively. Conclusions: Regional differences were observed in the clinical presentation of MUCD-recorded RCC and in area-level healthcare resource availability. These findings are descriptive and hypothesis-generating and do not show that differences in resource availability caused the observed clinical patterns.