2008 Annual Meeting Abstracts

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Competing Causes of Death in Patients with Kidney Cancer
David J Kaplan*, David A Kunkle*, Brian L Egleston, Yu-Ning Wong, Ismael Saad, Robert G Uzzo
Fox Chase Cancer Center, Philadelphia, PA

Introduction: Incidental detection of small renal masses(SRM) has led to an increased incidence of Renal Cell Carcinoma(RCC). Development of metastases is uncommon in trials of active surveillance for SRMs. Although stage migration has been well documented, there has not been a significant improvement in cancer-specific or overall survival for patients with RCC.
Methods: Mortality and survival rates in the United States were determined from 2003 National Vital Statistics Reports. Patients were stratified into 5 age categories. Mortality was classified as RCC, non-RCC cancers, and non-cancer causes. Additionally Survival, Epidemiology, and End Results(SEER) database was queried for observed, expected, and relative 5-year survival in patients with localized RCC.
Results: 5-year mortality data for 2,448,288 deaths were analyzed. Nearly 25% of the US population >75 and 55% >85 will die of other causes within 5 years. In people >75 years old, the risk of death from RCC represents a very small percentage of mortality. Also, patients treated surgically for localized kidney cancer have a 5-year relative survival ≥90% across all ages compared to 48% or less in patients treated without surgery.
Conclusions: Mortality from RCC represents a small fraction of all causes of death. Five-year mortality from competing causes increases with age. Also, patients treated surgically for localized kidney cancer have significantly better relative survival compared to patients treated without surgery across all ages. Active surveillance of SRMs may be appropriate for selected elderly and co-morbid patients when their risk of mortality from competing causes supercedes their likelihood of death from RCC.

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