Hispanics and American Indians (AI) have high kidney cancer incidence and mortality rates in Arizona. This study assessed: (1) whether racial and ethnic minority patients and patients from neighborhoods with high social vulnerability index (SVI) experience a longer time to surgery after clinical diagnosis, and (2) whether time to surgery, race and ethnicity, and SVI are associated with upstaging to pT3/pT4, disease-free survival (DFS), and overall survival (OS).
Arizona Cancer Registry (2009-2018) kidney and renal pelvis cases (n = 4592) were analyzed using logistic regression models to assess longer time to surgery and upstaging. Cox-regression hazard models were used to test DFS and OS.
Hispanic and AI patients with T1 tumors had a longer time to surgery than non-Hispanic White patients (median time of 56, 55, and 45 days, respectively). Living in neighborhoods with high (≥75) overall SVI increased odds of a longer time to surgery for cT1a (OR 1.54, 95% CI: 1.02-2.31) and cT2 (OR 2.32, 95% CI: 1.13-4.73). Race and ethnicity were not associated with time to surgery. Among cT1a patients, a longer time to surgery increased odds of upstaging to pT3/pT4 (OR 1.95, 95% CI: 0.99-3.84). A longer time to surgery was associated with PFS (HR 1.52, 95% CI: 1.17-1.99) and OS (HR 1.63, 95% CI: 1.26-2.11). Among patients with cT2 tumor, living in high SVI neighborhoods was associated with worse OS (HR 1.66, 95% CI: 1.07-2.57).
High social vulnerability was associated with increased time to surgery and poor survival after surgery.
Cancer medicine. 2024 Feb [Epub]
Celina I Valencia, Patrick Wightman, Kristin E Morrill, Chiu-Hsieh Hsu, Hina Arif-Tiwari, Eric Kauffman, Francine C Gachupin, Juan Chipollini, Benjamin R Lee, David O Garcia, Ken Batai
Department of Family and Community Medicine, College of Medicine - Tucson, The University of Arizona, Tucson, Arizona, USA., Center for Population Health Sciences, The University of Arizona, Tucson, Arizona, USA., Community and Systems Health Science Division, College of Nursing, The University of Arizona, Tucson, Arizona, USA., Department of Epidemiology and Biostatistics, The University of Arizona, Tucson, Arizona, USA., Department of Medical Imaging, The University of Arizona, Tucson, Arizona, USA., Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA., Department of Urology, The University of Arizona, Tucson, Arizona, USA., Department of Health Promotion Sciences, The University of Arizona, Tucson, Arizona, USA., Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA.