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Kidney Cancer and Competing Causes of Mortality: An Age-based Population Study
David A Kunkle*, Brian L Egleston*, Robert G Uzzo
Fox Chase Cancer Center, Temple University School of Medicine, Philadelphia, PA
Introduction: The rising incidence of renal cell carcinoma (RCC) due to incidental detection of small renal masses (SRM) has been associated with a stage migration. Unfortunately this has not resulted in a significant improvement in cancer-specific or overall survival for patients with RCC. Recent data regarding active surveillance of the SRM has demonstrated a low incidence of progression to M+ disease. We analyzed competing causes of mortality as a function of patient age in a population-based study.
Methods: Results from the National Vital Statistics Reports were used to determine survival rates and mortality in the United States. Patients were stratified into 5 age categories. Death rates were classified as related to non-cancer mortality, non-RCC cancer mortality, or RCC related mortality.
Results: Five-year mortality data for 2,448,288 US deaths (in 2003) were compiled and analyzed for cause of death (Table). Nearly 25% of patients over 75 and 55% of patients over 85 will die of other causes within 5 years while the overall risk of death from RCC represented a very small percentage in this cohort.
Conclusions: Mortality from RCC represents a small fraction of all causes of death in the United States. Five-year mortality from competing causes increases with increasing patient age. These data suggest that active surveillance of renal tumors may be appropriate for selected elderly and comorbid patients.
Five-year causes of mortality in the United States.| Age Group | 5-year Mortality from Kidney Cancer, (%) | 5-year Mortality from Other Cancers, (%) | 5-year Mortality from Non-Cancer Causes, (%) | 5-year All-cause Overall Survival (%) | | 45-54 years | 0.01 | 0.6 | 1.5 | 97.9 | | 55-64 years | 0.04 | 1.6 | 2.9 | 95.4 | | 65-74 years | 0.08 | 3.6 | 7.1 | 89.2 | | 75-84 years | 0.12 | 5.7 | 18.7 | 75.5 | | 85 years and over | 0.12 | 6.2 | 48.2 | 45.4 |
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