Clinicopathologic features and survival disparities in early onset clear cell renal cell carcinoma in Texas.
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BACKGROUND: Early onset renal cell carcinoma (EORCC), defined as diagnosis at <47 years, accounts for 3% to 7% of all renal cell carcinoma cases, and the incidence has increased significantly. Up to 82.3% of EORCC cases are clear cell type (EOccRCC). Comprehensive data on the clinicopathologic features and survival outcomes in this subgroup remain limited. This study aimed to investigate the clinicopathologic characteristics and survival patterns of EOccRCC in Texas. METHODS: This cohort study utilized anonymized data from the Texas Cancer Registry to examine cases of EOccRCC. Clinicopathologic features were analyzed, and survival outcomes were assessed using log-rank (Mantel-Cox) tests and Kaplan-Meier survival curve analyses. Patients in different ethnic groups were compared using post hoc pairwise chi-square tests for baseline characteristics, and adjusted hazard ratios of all-cause and cancer-specific mortality with multivariable Cox models were reported. RESULTS: A total of 4223 EOccRCC cases (age range 5-46 years, mean age 39.7) were identified. The majority of patients were male (60.1%), White (90.7%), non-Hispanic (57.3%), and obese (61.9%). At the time of diagnosis, 76.3% of patients had American Joint Committee on Cancer (AJCC) stage 1 disease and 6.7% had stage 4 disease. By the last follow-up, 13.1% of patients had died, with half of the deaths attributed to ccRCC. Mexican Hispanic ethnicity had a poorer prognosis (P < 0.001), whereas obesity (body mass index ≥ 30 kg/m2) had an increased trend of long-term cancer-specific survival (P < 0.001). Other significant prognostic factors included AJCC stage, distant metastasis, tumor size, age, and sex. Mexican Hispanic patients were more likely to present with advanced disease, larger tumor size, uninsured status, and high neighborhood poverty, in comparison to non-Hispanic and other Hispanic patients. In adjusted analyses, Mexican Hispanic ethnicity was associated with higher all-cause and disease-specific mortality versus non-Hispanic, while other Hispanic patients had lower mortality compared to non-Hispanic. CONCLUSIONS: EOccRCC trends increased in Texas and showed multiple discrepancies in clinicopathologic features and survival. Mexican Hispanic patients presented with more advanced disease, higher rates of being uninsured, and greater neighborhood poverty level and demonstrated poorer prognosis compared to non-Hispanic and other Hispanic populations.