Survival Differences of Localized Papillary Renal Cell Carcinoma in African Americans vs. European Americans

PURPOSE: African Americans exhibit a higher prevalence of papillary renal cell carcinoma (pRCC). We assessed overall and cause-specific survival differences between African Americans and European Americans with surgically treated localized pRCC. METHODS: African Americans and European Americans who underwent nephrectomy for T1b-2 N0 M0 pRCC were identified within the Surveillance, Epidemiology and End Results database (2004-2021). Propensity score matching (PSM) was applied, and multivariable Cox regression as well as competing-risks regression (CRR) models were fitted. RESULTS: Of 3,707 patients, 1,345 (36.3%) were African Americans and 2,362 (63.7%) were European Americans. After PSM, no significant differences in socioeconomic, demographic, or tumor-specific characteristics remained between the two groups. Overall survival (OS) rates at 120 months after nephrectomy were 59.4% in African Americans vs. 66.9% in European Americans (p = 0.026). In multivariable Cox regression models, the African American group was associated with higher overall mortality (hazard ratio [HR] 1.24, 95% confidence interval [CI]: 1.05-1.47, p = 0.013). Other-cause mortality (OCM) at 120 months after nephrectomy was higher in African Americans (29.0% vs. 22.2%), while cancer-specific mortality (CSM) did not differ (11.0% vs. 10.3%) between the two populations. Finally, in multivariable CRR models, the African American group predicted higher OCM (HR 1.33, 95% CI: 1.08-1.64, p = 0.007), but did not affect CSM (HR 1.06, 95% CI: 0.77-1.45, p = 0.7). CONCLUSION: In surgically treated localized pRCC, OS in African American patients is lower compared to European American patients. This difference in OS is not explained by CSM. Instead, it reflects significantly higher OCM in African American patients.