ORIGINAL RESEARCH Contemporary incidence and mortality rates of kidney cancer in the United States Giorgio Gandaglia, MD? Praful Ravi, MD? Firas Abdollah, MD? Abd-EI-Rahman M. Abd-EI-Barr, MD? Andreas Becker, MD^Ioana Popa, MD?Alberto Brigand, MD? Pierre I. Karakiewicz, MD, FRCSCS Quoc-Dien Trinh, MD, FRCSCf Michael A. Jewett, MD, FRCSC? Maxine Sun, BScs 'Department of Urology, Vita Salute San Raffaele University, Milan, Italy; fWest Middlesex University Hospital, London, United Kingdom; 'Vottikuti Urology Institute, Henry Ford Health Systems, Detroit, Ml; §Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC; ‘ Department of Urology, Prostate Cancer Center, University of Hamburg-Eppendorf, Hamburg, Germany; 'Department of Surgery, Division of Urology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; “Department of Surgicol Oncology, Division of Urology, University Health Network, Toronto, ON Cite as: Can Urol Assoc J 2014;8(7-8):247-52. http://dx.doi.org/10.5489/cuaj.1760 Published online August 11,2014.
Abstract Introduction: This is a tim e ly update o f in cid e n ce and m o rta lity fo r renal cell carcino m a (RCC) in the U nited States. Methods: R e lyin g on the S urve illan ce, E p id e m io lo g y, and End Results (SEER) database, w e c o m p u te d age-adjusted in cide nce , m ortality rates and 5-year cancer-specific survival (CSS) for patients w ith h is to lo g ic a lly c o n firm e d kid ne y cancer betw een 1975 and 2009. Long-term (1 9 75 -200 9) and short-term (2 0 0 0 -2 0 0 9 ) trends w e re exa m in e d by jo in p o in t analysis, and q u a n tifie d using the annual percent change (APC). The reported findings were stratified acco rding to disease stage. Results: Age-adjusted incidence rates o f RCC increased by + 2.76 % / year between 1975 and 2009 (from 6.5 to 17.1/100 000 personyears, p < 0.001), and by + 2.85 % /year between 20 00 and 2009 (p < 0 .0 0 1 ). For the same tim e po in ts, the c o rre s p o n d in g APC fo r the in c id e n c e o f lo c a liz e d stage w e re + 4 .5 5 % /y e a r (from 3.0 to 12 .2/100 000 person years, p < 0.001), and + 4.42 % /year (p < 0.001), resp ective ly. The in cid e n ce rates o f regional stage increased by + 0.88 % /year between 1975 and 2009 (p < 0.001), but stabilized in recent years (2 0 0 0 -2 0 0 9 : +0.56% /year, p = 0.4). Incidence rates o f distant stage rem ained unchanged in long- and short-term trends. O verall m ortality rates increased by + 1 ,72% /year betw een 1975 and 20 09 (from 1.2 to 5.0 /1 0 0 000 person-years, PcO.001), but stabilized between 1994 and 2004 (p = 0.1). Short term m o rta lity rates increased in a sig nifica nt fashion by + 3 .1 4 % / year o n ly fo r lo calized stage (p < 0.001). Interpretation: In contem porary years, there is a persisting upward trend in in cide nce and m o rta lity o f lo calized RCC.
Introduction An estimated 64 770 new cases of kidney cancer were diag nosed in 2012 in the United States, with about 13 570 new deaths due to the disease.1 Previous studies reported that the
incidence of kidney cancer showed no signs of stabilizing over the past 3 decades,24 coinciding with an increased use of imaging, namely abdominal ultrasound and computed tomography (CT).5 This postulation is somewhat substanti ated given that previous reports showed that the increase in incidence was predominantly driven by localized stage.2 However, such trends may have changed in recent years for two reasons. First, decreasing incidence rates for several cancers have been reported.6 Second, a recent study showed a plateau, and even reduction, in the use of imaging studies between 2006 and 2010.7 Under this setting, we sought to examine how these changes may have affected incidence and mortality rates of kidney cancer over time. We hypoth esized that incidence rates of kidney cancer should also have decreased, or at the minimum stabilized, in recent years.
Methods
Study source Population-based data on cancer incidence were abstract ed from the National Cancer Institute (NCI)'s Surveillance, Epidemiology, and End Results (SEER) program. The identifi cation of individuals with kidney cancer diagnosed between 1975 and 2009 were based on 13 cancer registries in the SEER Program and account for about 14% of the US population.8
Study population Patients w ith histologically confirmed cases of cancers of the kidney parenchyma, or kidney not otherwise specified (International Classification of Diseases Oncology [IC D 0 - 2 ], site code C64.9) were abstracted using previously described methodologies.2-3 For the purpose of the analyses, we excluded in situ and unstaged disease. Moreover, analy ses were restricted to patients aged &18 years old.
CUAI • July-August 2014» Volume 8, Issues 7-8 © 2014 Conodian Urological Association
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Gandaglia et al.
Table 1. D escription o f th e staging system defined by th e Surveillance, Epidem iology, and End Results (SEER) database SEER stage
Description
Localized
An invasive malignant cancer confined entirely to the organ of origin.
Regional
A malignant cancer that (1 ) has extended beyond the limits of the organ of origin directly into surrounding organs or tissues; (2) involves regional lymph nodes by way of lymphatic system; or (3) has both regional extension and involvement of regional to distant organs, tissues, or via the lymphatic system to distant lymph nodes.
Distant
A malignant cancer that has spread to parts of the body remote from the primary tumour either by direct extension or by discontinuous metastasis to distant organs, tissues, or via the lymphatic system to distant lymph nodes.
the 5-year cancer-specific survival (CSS) were computed w ithin the entire cohort, and stratified according to disease stage. Incidence rates and incidence-based mortality rates were adjusted to the 2000 United States standard popula tion, and calculated per 100 000 person-years. Temporal trends of age-adjusted rates were assessed using joinpoint regression, which involves fitting a series of joined straight lines on a logarithmic scale to the trends in the annual ageadjusted rates,9 and quantified using the annual percent change (APC). Both long-term (1975-2009) and short-term (2000-2009) trends were examined. The time frame interval for short-term trends assessment in mortality rates were lim ited to diagnoses between 1994 and 2004, to allow at least 5 years of follow-up. The t test was used to assess whether the APCs were statistically significantly different. All statistical tests were two-sided, with a significance level set at 0.05.
SEER: Surveillance, Epidemiology, and End Results.
Results Statistical analyses Incidence For the purpose of our analyses, cases were grouped accord ing to SEER staging systems, defined as localized, regional and distant (Table 1). O verall incidence, m ortality, and
0
Overall age-adjusted incidence of kidney cancer steadily increased by +2.76%/year (95% confidence interval [Cl]
B
Fig. 1. Overall age-adjusted incidence rates of kidney cancer [A] and stratified according to disease stage [B], Surveillance, Epidemiology, and End Results (SEER), 1975-2009.
248
CUAJ • July-August 2 0 1 4 » Volume 8, Issues 7-8
Kidney cancer in the United States
B
100% 90%
i i i
80% * 70% co 60% (/> U 50% |
40%
uS 30% 20 % 10% r)(D N C 0 0 )O ^ C M C 0 t^ '0 ^ C 0 0 )O 'r-0 jn 'J lfi(D M » 0 1 O T -M (0 T tin ' S NNS CDC0 ( 0 C0 C0 t 0 C0 C0 C0 C0 0 ) CT ) 0 ) 0 ) 0 1 f f l Cn 0 ) 0 ) 0 ) OOOOOO D 0) ( j ) 0) 010) 010) t 3) f f l c 5 ) ® 0) 0) r o 0) 0) 01010) 0) ® 0) 0) 0 ) 0 0 0 0 0 0 -^T -T -T -'< -T -T -T -T -T -T -1-^-T -'t--^-T -T -T -T -T -T -T -T -C M C M C \lC S JC S JC 'J
0% ) (D S
CO O) O - • .............. ............................. — .................» ------------------------------ -------------0 c0 c0 c0 (»c 0 c0 c0 c0 c00) 0) 0) 01010) 0) 0) 050) 0 0 0 0 (___ )0)0)0)0101010)0)0)0)G)0)0)0)01010)010)0)0)0)0)0)000000 -T-T-T-T-1-T-T-t-T-T-T-T-T-T-T-T-1-T-T-T-^-T-T-T-
Abstract Introduction: This is a tim e ly update o f in cid e n ce and m o rta lity fo r renal cell carcino m a (RCC) in the U nited States. Methods: R e lyin g on the S urve illan ce, E p id e m io lo g y, and End Results (SEER) database, w e c o m p u te d age-adjusted in cide nce , m ortality rates and 5-year cancer-specific survival (CSS) for patients w ith h is to lo g ic a lly c o n firm e d kid ne y cancer betw een 1975 and 2009. Long-term (1 9 75 -200 9) and short-term (2 0 0 0 -2 0 0 9 ) trends w e re exa m in e d by jo in p o in t analysis, and q u a n tifie d using the annual percent change (APC). The reported findings were stratified acco rding to disease stage. Results: Age-adjusted incidence rates o f RCC increased by + 2.76 % / year between 1975 and 2009 (from 6.5 to 17.1/100 000 personyears, p < 0.001), and by + 2.85 % /year between 20 00 and 2009 (p < 0 .0 0 1 ). For the same tim e po in ts, the c o rre s p o n d in g APC fo r the in c id e n c e o f lo c a liz e d stage w e re + 4 .5 5 % /y e a r (from 3.0 to 12 .2/100 000 person years, p < 0.001), and + 4.42 % /year (p < 0.001), resp ective ly. The in cid e n ce rates o f regional stage increased by + 0.88 % /year between 1975 and 2009 (p < 0.001), but stabilized in recent years (2 0 0 0 -2 0 0 9 : +0.56% /year, p = 0.4). Incidence rates o f distant stage rem ained unchanged in long- and short-term trends. O verall m ortality rates increased by + 1 ,72% /year betw een 1975 and 20 09 (from 1.2 to 5.0 /1 0 0 000 person-years, PcO.001), but stabilized between 1994 and 2004 (p = 0.1). Short term m o rta lity rates increased in a sig nifica nt fashion by + 3 .1 4 % / year o n ly fo r lo calized stage (p < 0.001). Interpretation: In contem porary years, there is a persisting upward trend in in cide nce and m o rta lity o f lo calized RCC.
Introduction An estimated 64 770 new cases of kidney cancer were diag nosed in 2012 in the United States, with about 13 570 new deaths due to the disease.1 Previous studies reported that the
incidence of kidney cancer showed no signs of stabilizing over the past 3 decades,24 coinciding with an increased use of imaging, namely abdominal ultrasound and computed tomography (CT).5 This postulation is somewhat substanti ated given that previous reports showed that the increase in incidence was predominantly driven by localized stage.2 However, such trends may have changed in recent years for two reasons. First, decreasing incidence rates for several cancers have been reported.6 Second, a recent study showed a plateau, and even reduction, in the use of imaging studies between 2006 and 2010.7 Under this setting, we sought to examine how these changes may have affected incidence and mortality rates of kidney cancer over time. We hypoth esized that incidence rates of kidney cancer should also have decreased, or at the minimum stabilized, in recent years.
Methods
Study source Population-based data on cancer incidence were abstract ed from the National Cancer Institute (NCI)'s Surveillance, Epidemiology, and End Results (SEER) program. The identifi cation of individuals with kidney cancer diagnosed between 1975 and 2009 were based on 13 cancer registries in the SEER Program and account for about 14% of the US population.8
Study population Patients w ith histologically confirmed cases of cancers of the kidney parenchyma, or kidney not otherwise specified (International Classification of Diseases Oncology [IC D 0 - 2 ], site code C64.9) were abstracted using previously described methodologies.2-3 For the purpose of the analyses, we excluded in situ and unstaged disease. Moreover, analy ses were restricted to patients aged &18 years old.
CUAI • July-August 2014» Volume 8, Issues 7-8 © 2014 Conodian Urological Association
247
Gandaglia et al.
Table 1. D escription o f th e staging system defined by th e Surveillance, Epidem iology, and End Results (SEER) database SEER stage
Description
Localized
An invasive malignant cancer confined entirely to the organ of origin.
Regional
A malignant cancer that (1 ) has extended beyond the limits of the organ of origin directly into surrounding organs or tissues; (2) involves regional lymph nodes by way of lymphatic system; or (3) has both regional extension and involvement of regional to distant organs, tissues, or via the lymphatic system to distant lymph nodes.
Distant
A malignant cancer that has spread to parts of the body remote from the primary tumour either by direct extension or by discontinuous metastasis to distant organs, tissues, or via the lymphatic system to distant lymph nodes.
the 5-year cancer-specific survival (CSS) were computed w ithin the entire cohort, and stratified according to disease stage. Incidence rates and incidence-based mortality rates were adjusted to the 2000 United States standard popula tion, and calculated per 100 000 person-years. Temporal trends of age-adjusted rates were assessed using joinpoint regression, which involves fitting a series of joined straight lines on a logarithmic scale to the trends in the annual ageadjusted rates,9 and quantified using the annual percent change (APC). Both long-term (1975-2009) and short-term (2000-2009) trends were examined. The time frame interval for short-term trends assessment in mortality rates were lim ited to diagnoses between 1994 and 2004, to allow at least 5 years of follow-up. The t test was used to assess whether the APCs were statistically significantly different. All statistical tests were two-sided, with a significance level set at 0.05.
SEER: Surveillance, Epidemiology, and End Results.
Results Statistical analyses Incidence For the purpose of our analyses, cases were grouped accord ing to SEER staging systems, defined as localized, regional and distant (Table 1). O verall incidence, m ortality, and
0
Overall age-adjusted incidence of kidney cancer steadily increased by +2.76%/year (95% confidence interval [Cl]
B
Fig. 1. Overall age-adjusted incidence rates of kidney cancer [A] and stratified according to disease stage [B], Surveillance, Epidemiology, and End Results (SEER), 1975-2009.
248
CUAJ • July-August 2 0 1 4 » Volume 8, Issues 7-8
Kidney cancer in the United States
B
100% 90%
i i i
80% * 70% co 60% (/> U 50% |
40%
uS 30% 20 % 10% r)(D N C 0 0 )O ^ C M C 0 t^ '0 ^ C 0 0 )O 'r-0 jn 'J lfi(D M » 0 1 O T -M (0 T tin ' S NNS CDC0 ( 0 C0 C0 t 0 C0 C0 C0 C0 0 ) CT ) 0 ) 0 ) 0 1 f f l Cn 0 ) 0 ) 0 ) OOOOOO D 0) ( j ) 0) 010) 010) t 3) f f l c 5 ) ® 0) 0) r o 0) 0) 01010) 0) ® 0) 0) 0 ) 0 0 0 0 0 0 -^T -T -T -'< -T -T -T -T -T -T -1-^-T -'t--^-T -T -T -T -T -T -T -T -C M C M C \lC S JC S JC 'J
0% ) (D S
CO O) O - • .............. ............................. — .................» ------------------------------ -------------0 c0 c0 c0 (»c 0 c0 c0 c0 c00) 0) 0) 01010) 0) 0) 050) 0 0 0 0 (___ )0)0)0)0101010)0)0)0)G)0)0)0)01010)010)0)0)0)0)0)000000 -T-T-T-T-1-T-T-t-T-T-T-T-T-T-T-T-1-T-T-T-^-T-T-T-
