Year of Publication

2018

College

Public Health

Degree Name

Master of Public Health (M.P.H.)

Committee Chair

Steven Fleming, PhD

Committee Member

Steven Browning, MSPH, PhD

Committee Member

Bin Huang, DrPH, MS

Abstract

Introduction:

Renal cell carcinoma (RCC) is an important cause of morbidity and mortality in our country. Previously reported data suggest that the overall incidence of RCC continues to rise and may be accelerating even faster among younger adult patients.

Methods:

Data for analysis included the combined NPCR-SEER USCS public use database and the Kentucky Cancer Registry dataset. Incidence rates and trends by age group and location were calculated and tested. Clinicopathologic features of disease among Kentucky cases were analyzed by age group. Cancer-specific survival (CSS) analysis was performed, along with Cox proportional hazards regression to test for association of younger age with improved CSS.

Results:

Incidence of RCC is higher in KY than in the rest of the country, and the rate is increasing faster, especially among younger adults. Annual percent change (APC) for patients in the 20-39 year-old age group was 8.5% (95% CI 5.9-11.2%), compared to only 4.4% (95% CI 3.5-5.3%) for the same age group in the rest of the country. APC among older patients in KY was 5.4% (95% CI 3.4-7.5%) for ages 40-49 and 1.8% (95% CI 0.8-2.9%) for ages 50+. Younger adult patients in KY were significantly more likely to be diagnosed with RCC of lower stage, lower grade, and more favorable histologic subtype. Survival curves by age group were similar when stratified by disease stage. Cox proportional hazards regression analysis revealed hazard ratio (HR) of 0.72 (95% CI 0.47-1.09) for the 19-39 age group and 0.61 (95% CI 0.49-0.76) for the 40-49 age group relative to the 50+ age group, adjusted for sex, stage, grade, and subtype.

Conclusion:

Young adults in Kentucky are increasingly likely to be diagnosed with RCC. However, they tend to have more favorable disease features compared to older adults, and possibly improved survival. More work will be needed to determine potential causes and implications of accelerating incidence, as well as to guide treatment decisions and post-treatment surveillance for these patients.

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