BACKGROUND: We tested for other-cause mortality (OCM) differences according to race/ethnicity in metastatic renal cell carcinoma (mRCC). Such differences may affect treatment considerations. METHODS: Within the Surveillance, Epidemiology, and End Results Research Plus repository (2000-2018), we identified clear cell (ccmRCC) and non-clear cell (non-ccmRCC) mRCC patients and stratified according to race/ethnicity: Caucasian vs. Hispanic vs. African American vs. Asian. Poisson smoothed cumulative incidence plots and competing risks regression (CRR) models addressing OCM, after adjustment for cancer-specific mortality , were fitted. Subsequently, multivariable logistic regression models tested access to cytoreductive nephrectomy (CNT) and systemic therapy (ST). RESULTS: Of 10,958 ccmRCC patients, 7,892 (72%), 1,743 (16%), 688 (6%), and 635 (6%) were Caucasian, Hispanic, African American, and Asian, respectively. Of 1,239 non-ccmRCC patients, 799 (64%), 106 (9%), 278 (22%), and 56 (5%) were Caucasian, Hispanic, African American, and Asian, respectively. In multivariable CRR models, OCM was higher in African Americans vs. Caucasians in ccmRCC (HR:1.55; CI:1.19-2.01; P < 0.001) and in non-ccmRCC (HR:1.54; CI:1.01-2.35; P = 0.04). In multivariable logistic regression models, African Americans with ccmRCC were less likely to undergo CNT (OR:0.72, CI:0.60-0.86; P < 0.001), but more likely to undergo ST (OR:1.34, CI:1.11-1.61; P = 0.002). CONCLUSIONS: In this retrospective analysis, African Americans with ccmRCC and non-ccmRCC exhibited higher OCM than Caucasians. Based on higher OCM, African Americans were less likely to undergo CNT, but more likely to benefit from ST.

Cancer Prognostics and Health Outcomes Unit Division of Urology University of Montréal Health Center Montréal Québec Canada

Cancer Prognostics and Health Outcomes Unit Division of Urology University of Montréal Health Center Montréal Québec Canada; Department of Surgical and Diagnostic Integrated Sciences University of Genova Genova Italy

Cancer Prognostics and Health Outcomes Unit Division of Urology University of Montréal Health Center Montréal Québec Canada; Department of Urology University Hospital Frankfurt Frankfurt am Main Germany

Cancer Prognostics and Health Outcomes Unit Division of Urology University of Montréal Health Center Montréal Québec Canada; Department of Urology University of Verona Azienda Ospedaliera Universitaria Integrata di Verona

Cancer Prognostics and Health Outcomes Unit Division of Urology University of Montréal Health Center Montréal Québec Canada; Martini Klinik Prostate Cancer Center University Hospital Hamburg Eppendorf Hamburg Germany

Department of Surgical and Diagnostic Integrated Sciences University of Genova Genova Italy

Department of Urology and Division of Experimental Oncology URI Urological Research Institute IRCCS San Raffaele Scientific Institute Milan Italy

Department of Urology and Division of Experimental Oncology URI Urological Research Institute IRCCS San Raffaele Scientific Institute Milan Italy; Cancer Prognostics and Health Outcomes Unit Division of Urology University of Montréal Health Center Montréal Québec Canada

Department of Urology University Hospital Frankfurt Frankfurt am Main Germany

Department of Urology University of Verona Azienda Ospedaliera Universitaria Integrata di Verona

Departments of Urology Weill Cornell Medical College New York NeY ; Department of Urology University of Texas Southwestern Dallas TX; Department of Urology 2nd Faculty of Medicine Charles University Praga Czech Republic; Department of Urology Institute for Urology and Reproductive Health 1 M Sechenov 1st Moscow State Medical University Moscow Russia; Division of Urology Hourani Center for Applied Scientific Research Al Ahliyya Amman University Amman Jordan; Department of Urology Comprehensive Cancer Center Medical University of Vienna Vienna Austria

Martini Klinik Prostate Cancer Center University Hospital Hamburg Eppendorf Hamburg Germany; Department of Urology University Hospital Hamburg Eppendorf Hamburg Germany; Department of Urology Koc University Hospital Instanbul Turkey

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