Racial/ethnic minority groups have a disproportionate burden of kidney cancer. The objective of this study was to assess if race/ethnicity was associated with a longer surgical wait time (SWT) and upstaging in the pre-COVID-19 pandemic time with a special focus on Hispanic Americans (HAs) and American Indian/Alaska Natives (AIs/ANs). Medical records of renal cell carcinoma (RCC) patients who underwent nephrectomy between 2010 and 2020 were retrospectively reviewed (n = 489). Patients with a prior cancer diagnosis were excluded. SWT was defined as the date of diagnostic imaging examination to date of nephrectomy. Out of a total of 363 patients included, 34.2% were HAs and 8.3% were AIs/ANs. While 49.2% of HA patients experienced a longer SWT (≥90 days), 36.1% of Non-Hispanic White (NHW) patients experienced a longer SWT. Longer SWT had no statistically significant impact on tumor characteristics. Patients with public insurance coverage had increased odds of longer SWT (OR 2.89, 95% CI: 1.53-5.45). Public insurance coverage represented 66.1% HA and 70.0% AIs/ANs compared to 56.7% in NHWs. Compared to NHWs, HAs had higher odds for longer SWT in patients with early-stage RCC (OR, 2.38; 95% CI: 1.25-4.53). HAs (OR 2.24, 95% CI: 1.07-4.66) and AIs/ANs (OR 3.79, 95% CI: 1.32-10.88) had greater odds of upstaging compared to NHWs. While a delay in surgical care for early-stage RCC is safe in a general population, it may negatively impact high-risk populations, such as HAs who have a prolonged SWT or choose active surveillance.
Abstract: Leiomyosarcoma (LMS) is one of the most common forms of soft tissue sarcoma with approximately 2,500 cases per year in the United States. The symptoms LMS vary depending upon the location, size, and spread of the tumor. In early stages, it may not be associated with any obvious symptoms so diagnosis and treatment may be delayed. In some cases, it can grow quickly and behave aggressively. Most types of LMS occur in the abdomen or in the uterus; although, scrotal LMS can be a very rare presentation of the disease. Here we present our case of a large, ulcerated scrotal LMS originating from subcutaneous tissue but not invading spermatic cord or tunica. Radical orchiectomy with high ligation of spermatic cord was performed, and patient had an uneventful postoperative course. This disease entity remains rare in the literature, and warrants larger studies in order to better understand treatment and oncologic outcomes. When LMS is identified early and is removed by surgical excision, prognosis can be good and full recovery quite likely. When LMS is already large or has spread to other parts of the body, treatment is relatively more complex and the prognosis poor. Hence, prompt diagnosis and treatment of genitourinary LMS require prompt attention, referral to tertiary, referral center should be strongly considered.
Abstract Background: Hispanics and American Indians (AI) have a higher kidney cancer incidence and mortality in Arizona. This study assessed 1) whether racial and ethnic minority patients and patients from neighborhoods with high social vulnerability, measured using the social vulnerability Index (SVI), experience a longer time (in days) to surgical treatment for kidney cancer after clinical diagnosis, and 2) whether time to surgery, race and ethnicity, and neighborhood social vulnerability are associated with adverse pathology (upstaging to pT3), progression free survival (PFS), and overall survival (OS) in Arizona. Methods: Arizona Cancer Registry (2009-2018) data for kidney and renal pelvis cases were obtained. Logistic regression models were used to assess if SVI (<25, 25-49, 50-74, and ≥75 percentile) and race and ethnicity were associated with a longer time to surgical (>median time to surgery) and upstaging. Cox-regression hazard models were used to assess if time to surgery and SVI were associated with PFS and OS. Separate analyses were performed for each clinical stage (cT1a, cT1b, cT2, and cT3). Results: A total of 4,592 kidney and renal pelvis cases (16.6% Hispanics and 4.8% AI) were included. Hispanic and AI patients with T1 tumors had a longer time to surgery than NHW patients (median time of 56, 55, and 45 days respectively). In unadjusted models, Hispanic ethnicity was associated with a longer time to surgery for cT1a (OR 1.48, 95% CI:1.05-2.08) and cT1b (OR 1.87, 95% CI:1.14-3.07). Hispanic and AI patients were also more likely to live in neighborhoods with high SVI than NHW patients. Living in neighborhoods with high (≥75) versus low (<25) overall SVI increased odds of a longer time to surgical for cT1a (OR 1.54, 95% CI:1.02-2.31) and cT2 (OR 2.32, 95% CI:1.13-4.73) in adjusted models. In these adjusted models, Hispanic ethnicity was no longer significantly associated with time to surgery. Among cT1a patients, a longer time to surgery increased odds of upstaging to pT3 (OR 1.95, 95% CI: 0.99-3.84) and risk of mortality. A longer time to surgery was associated with PFS with HR 1.52 (95% CI: 1.17- 1.99) and OS with HR 1.63 (95% CI:1.26-2.11) even after adjusting for SVI. Living in neighborhoods with high concentrations of racial and ethnic minorities increased odds of upstaging (OR 2.88, 95% CI: 0.99-8.37) in cT1a and was associated with PFS in cT3 (HR 2.45, 95% CI: 1.01-4.77). Compared to patients living in neighborhoods with SVI<25, patients with cT1a and cT2 tumor living in neighborhoods with SVI≥75 had about a 60% increased risk of mortality (OS HR 1.57, 95% CI: 1.01-2.45 for cT1b and HR 1.66, 95%CI:1.07-2.57 for cT2). Conclusion: These findings demonstrate that high neighborhood social vulnerability is associated with increased time to surgery and risk of progression and mortality. Impact: Neighborhood-level social vulnerability partly accounts for kidney cancer disparities in Arizona. Interventions need to focus on neighborhoods with high social vulnerability to improve care coordination for kidney cancer. Citation Format: Celina I. Valencia, Patrick Wightman, Kristin Morrill, Chiu-Hsieh Hsu, Hina Arif-Tiwari, Eric Kauffman, Francine C. Gachupin, Juan Chipollini, Benjamin R. Lee, Ken Batai. Neighborhood social vulnerability and disparities in time to kidney cancer surgical treatment in Arizona [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B079.
497 Background: Although several guidelines outline management options for patients with renal masses, few studies describe treatment strategies and outcomes in octogenarians. We sought to review outcomes in this population managed with active surveillance (AS), partial nephrectomy (PN), or radical nephrectomy (RN). Methods: Data were collected on 113 octogenarian patients referred for management of renal masses at Moffitt Cancer Center between 2000 and 2013. Patients were treated with AS, PN, or RN. Univariate and multivariable Cox regression models measured association of management modality and survival. Kaplan-Meier survival analysis was used for overall survival and log-rank tests were used to compare survival curves. Covariates include age, Eastern Cooperative Oncology Group (ECOG) score, clinical and pathologic stage, tumor size, creatinine, creatinine clearance, and overall survival. Results: Out of 113 patients, 27 (22%) underwent AS, 33 (26.8%) underwent PN, and 53 (43%) underwent RN. The mean age was 83 years (range, 80-92). AS patients had a higher mean age (84 years) than PN patients (81.9 years), but not with RN patients (83 years) (p=0.008). At a median follow-up of 30.6 months (IQR 9.9-56), 13 (48%), 10 (30.3%), and 29 (54.7%) patients died from any cause in AS, PN, and RN patients respectively. PN patients tended to have a longer median overall survival at 81 months versus 55.8 and 57 months for AS and RN respectively, but this did not reach statistical significance on univariate (p=0.588) or multivariate analysis (p=0.29). On subgroup analysis of cT1a patients, there was also no difference in overall survival among treatment arms on univariate (p=0.654) and multivariate analysis (p=0.47). At 1 year follow-up, there was no difference in creatinine levels between treatment arms (p=0.331). However, mean creatinine clearance was lower in RN patients (35.8 ml/min) compared to AS (50.7 ml/min) and PN (48.1 ml/min) (p=0.024). Conclusions: Active treatment with PN and RN may not provide a survival advantage among octogenarians. Renal function was inferior in RN patients but comparable between AS and PN patients at 1 year follow-up.
