Advertisement

International Urology and Nephrology

, Volume 51, Issue 12, pp 2181–2188 | Cite as

Unmarried status is a barrier for access to treatment in patients with metastatic renal cell carcinoma

  • Giuseppe RosielloEmail author
  • Sophie Knipper
  • Carlotta Palumbo
  • Cristina Dzyuba-Negrean
  • Angela Pecoraro
  • Elio Mazzone
  • Francesco A. Mistretta
  • Zhe Tian
  • Umberto Capitanio
  • Francesco Montorsi
  • Shahrokh F. Shariat
  • Fred Saad
  • Alberto Briganti
  • Pierre I. Karakiewicz
Urology - Original Paper

Abstract

Purpose

We tested the effect of marital status on cytoreductive nephrectomy, metastasectomy, and systemic therapy rates, as well as on cancer-specific mortality (CSM) in patients with metastatic clear cell renal carcinoma (mccRCC).

Methods

Within the Surveillance, Epidemiology and End Results database (2004–2015), we identified 6975 patients (4806 men and 2169 women) with metastatic clear cell renal carcinoma. Temporal trend analyses, logistic regression models, cumulative incidence plots, and competing-risk regression models were used.

Results

Overall, 1450 men and 1018 women were unmarried (30.2% and 47.0%, respectively). In men, unmarried status was an independent predictor of lower cytoreductive nephrectomy rate (OR: 0.54), lower metastasectomy rate (OR: 0.70), and lower systemic therapy rate (OR: 0.70). Conversely, in women, unmarried status was an independent predictor of lower cytoreductive nephrectomy rate (OR: 0.63) and of lower systemic therapy rate (OR: 0.80), but not of lower metastasectomy rate (OR: 0.83; p = 0.12). In multivariable competing-risk regression analyses, unmarried status was an independent predictor of higher CSM in men (HR: 1.15), but not in women (HR 0.97, p = 0.6).

Conclusions

Unmarried men are at higher risk of not benefiting of cytoreductive nephrectomy, metastasectomy, or systemic therapy than their married counterparts. Unmarried women are at higher risk of not benefiting of cytoreductive nephrectomy or systemic therapy. These gender-related differences cumulate in higher CSM in unmarried men, but not in unmarried women.

Keywords

Clear cell Kidney cancer Marital status Metastatic SEER database Survival 

Notes

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

All authors declare no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

References

  1. 1.
    Abdollah F, Sun M, Thuret R, Abdo A, Morgan M, Jeldres C et al (2011) The effect of marital status on stage and survival of prostate cancer patients treated with radical prostatectomy: a population-based study. Cancer Causes Control 22:1085–1095.  https://doi.org/10.1007/s10552-011-9784-x CrossRefPubMedGoogle Scholar
  2. 2.
    Sammon JD, Morgan M, Djahangirian O, Trinh Q-D, Sun M, Ghani KR et al (2012) Marital status: a gender-independent risk factor for poorer survival after radical cystectomy: marital status and survival after radical cystectomy. BJU Int 110:1301–1309.  https://doi.org/10.1111/j.1464-410X.2012.10993.x CrossRefPubMedGoogle Scholar
  3. 3.
    Capitanio U, Bensalah K, Bex A, Boorjian SA, Bray F, Coleman J et al (2019) Epidemiology of renal cell carcinoma. Eur Urol 75:74–84.  https://doi.org/10.1016/j.eururo.2018.08.036 CrossRefPubMedGoogle Scholar
  4. 4.
    Fosså SD, Cvancarova M, Chen L, Allan AL, Oldenburg J, Peterson DR et al (2011) Adverse prognostic factors for testicular cancer-specific survival: a population-based study of 27,948 patients. J Clin Oncol 29:963–970.  https://doi.org/10.1200/JCO.2010.32.3204 CrossRefPubMedGoogle Scholar
  5. 5.
    He X-K, Lin Z-H, Qian Y, Xia D, Jin P, Sun L-M (2017) Marital status and survival in patients with primary liver cancer. Oncotarget.  https://doi.org/10.18632/oncotarget.11066 CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Goodwin JS, Hunt WC, Key CR, Samet JM (1987) The effect of marital status on stage, treatment, and survival of cancer patients. JAMA 258:3125–3130.  https://doi.org/10.1001/jama.1987.03400210067027 CrossRefPubMedGoogle Scholar
  7. 7.
    Miao T, Li Y, Sheng X, Yao D (2017) Marital status and survival of patients with kidney cancer. Oncotarget.  https://doi.org/10.18632/oncotarget.21029 CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Aizer AA, Chen M-H, McCarthy EP, Mendu ML, Koo S, Wilhite TJ et al (2013) Marital status and survival in patients with cancer. J Clin Oncol 31:3869–3876.  https://doi.org/10.1200/JCO.2013.49.6489 CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Marchioni M, Martel T, Bandini M, Pompe RS, Tian Z, Kapoor A et al (2017) Marital status and gender affect stage, tumor grade, treatment type and cancer specific mortality in T1–2 N0 M0 renal cell carcinoma. World J Urol 35:1899–1905.  https://doi.org/10.1007/s00345-017-2082-9 CrossRefPubMedGoogle Scholar
  10. 10.
    Li Y, Zhu M, Qi S (2018) Marital status and survival in patients with renal cell carcinoma. Medicine (Baltimore) 97:e0385.  https://doi.org/10.1097/MD.0000000000010385 CrossRefGoogle Scholar
  11. 11.
    Hellenthal NJ, Chamie K, Ramirez ML, deVere White RW (2009) Sociodemographic factors associated with nephrectomy in patients with metastatic renal cell carcinoma. J Urol 181:1013–1019.  https://doi.org/10.1016/j.juro.2008.10.159 CrossRefPubMedGoogle Scholar
  12. 12.
    Rampersaud EN, Klatte T, Bass G, Patard J-J, Bensaleh K, Böhm M et al (2014) The effect of gender and age on kidney cancer survival: younger age is an independent prognostic factor in women with renal cell carcinoma. Urol Oncol 32(30):e9–e13.  https://doi.org/10.1016/j.urolonc.2012.10.012 CrossRefGoogle Scholar
  13. 13.
    Krongrad A, Lai H, Burke MA, Goodkin K, Lai S (1996) Marriage and mortality in prostate cancer. J Urol 156:1696–1670CrossRefGoogle Scholar
  14. 14.
    Motzer RJ, Bacik J, Mariani T, Russo P, Mazumdar M, Reuter V (2002) Treatment outcome and survival associated with metastatic renal cell carcinoma of non-clear-cell histology. J Clin Oncol 20:2376–2381.  https://doi.org/10.1200/JCO.2002.11.123 CrossRefPubMedGoogle Scholar
  15. 15.
    Bhindi B, Wallis CJD, Boorjian SA, Thompson RH, Farrell A, Kim SP et al (2018) The role of lymph node dissection in the management of renal cell carcinoma: a systematic review and meta-analysis. BJU Int 121:684–698.  https://doi.org/10.1111/bju.14127 CrossRefPubMedGoogle Scholar
  16. 16.
    Kim DY, Karam JA, Wood CG (2014) Role of metastasectomy for metastatic renal cell carcinoma in the era of targeted therapy. World J Urol 32:631–642.  https://doi.org/10.1007/s00345-014-1293-6 CrossRefPubMedGoogle Scholar
  17. 17.
    Dabestani S, Marconi L, Hofmann F, Stewart F, Lam TBL, Canfield SE et al (2014) Local treatments for metastases of renal cell carcinoma: a systematic review. Lancet Oncol 15:e549–e561.  https://doi.org/10.1016/S1470-2045(14)70235-9 CrossRefPubMedGoogle Scholar
  18. 18.
    Larcher A, Wallis CJD, Bex A, Blute ML, Ficarra V, Mejean A et al (2019) Individualised indications for cytoreductive nephrectomy: which criteria define the optimal candidates? Eur Urol Oncol 2:365–378.  https://doi.org/10.1016/j.euo.2019.04.007 CrossRefPubMedGoogle Scholar
  19. 19.
    Ouzaid I, Capitanio U, Staehler M, Wood CG, Leibovich BC, Ljungberg B et al (2019) Surgical metastasectomy in renal cell carcinoma: a systematic review. Eur Urol Oncol.  https://doi.org/10.1016/j.euo.2018.08.028 CrossRefPubMedGoogle Scholar
  20. 20.
    Xiao W-J, Zhu Y, Dai B, Zhang H-L, Ye D-W (2015) Assessment of survival of patients with metastatic clear cell renal cell carcinoma after radical cytoreductive nephrectomy versus no surgery: a SEER analysis. Int Braz J Urol 41:288–295.  https://doi.org/10.1590/S1677-5538.IBJU.2015.02.15 CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Méjean A, Ravaud A, Thezenas S, Colas S, Beauval J-B, Bensalah K et al (2018) Sunitinib alone or after nephrectomy in metastatic renal-cell carcinoma. N Engl J Med 379:417–427.  https://doi.org/10.1056/NEJMoa1803675 CrossRefPubMedGoogle Scholar
  22. 22.
    Sharma V, Thompson RH (2019) Cytoreductive nephrectomy in the wake of CARMENA: when to consider it. Eur Urol Oncol.  https://doi.org/10.1016/j.euo.2019.05.003 CrossRefPubMedGoogle Scholar
  23. 23.
    Palumbo C, Pecoraro A, Knipper S, Rosiello G, Tian Z, Shariat SF et al (2019) Survival and complication rates of metastasectomy in patients with metastatic renal cell carcinoma treated exclusively with targeted therapy: a combined population-based analysis. Anticancer Res 39:4357–4361.  https://doi.org/10.21873/anticanres.13604 CrossRefPubMedGoogle Scholar
  24. 24.
    Hanna N, Sun M, Meyer CP, Nguyen PL, Pal SK, Chang SL et al (2016) Survival analyses of patients with metastatic renal cancer treated with targeted therapy with or without cytoreductive nephrectomy: a national cancer data base study. J Clin Oncol 34:3267–3275.  https://doi.org/10.1200/JCO.2016.66.7931 CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  • Giuseppe Rosiello
    • 1
    • 2
    Email author
  • Sophie Knipper
    • 1
    • 3
  • Carlotta Palumbo
    • 1
    • 4
  • Cristina Dzyuba-Negrean
    • 1
  • Angela Pecoraro
    • 1
    • 5
  • Elio Mazzone
    • 2
  • Francesco A. Mistretta
    • 1
    • 6
  • Zhe Tian
    • 1
  • Umberto Capitanio
    • 2
  • Francesco Montorsi
    • 2
  • Shahrokh F. Shariat
    • 7
  • Fred Saad
    • 1
  • Alberto Briganti
    • 2
  • Pierre I. Karakiewicz
    • 1
  1. 1.Cancer Prognostics and Health Outcomes Unit, Division of UrologyUniversity of Montreal Health CenterMontrealCanada
  2. 2.Department of Urology and Division of Experimental Oncology, URI, Urological Research InstituteIRCCS San Raffaele Scientific InstituteMilanItaly
  3. 3.Martini-Klinik Prostate Cancer CenterUniversity Hospital Hamburg-EppendorfHamburgGermany
  4. 4.Urology Unit, ASST Spedali Civili of Brescia, Department of Medical and Surgical Specialties, Radiological Science and Public HealthUniversity of BresciaBresciaItaly
  5. 5.Department of Urology, San Luigi Gonzaga HospitalUniversity of TurinTurinItaly
  6. 6.Department of UrologyEuropean Institute of OncologyMilanItaly
  7. 7.Department of UrologyMedical University of ViennaViennaAustria

Personalised recommendations