Lifestyle and Clinical Factors in a Nationwide Stage III and IV Renal Cell Carcinoma Study

SIMPLE SUMMARY: Our research focused on understanding how specific patient and clinical factors, present at the diagnosis of advanced renal cell carcinoma (RCC), influence the mortality and recurrence of the disease. We studied patients with advanced RCC from a national Danish database and monitored them over time. Our findings showed that having a positive surgical margin, synchronous metastasis, and poor health status were linked with a higher chance of death and recurrence of the disease. Interestingly, for non-ccRCC patients, having a multidisciplinary team (MDT) discussion during diagnosis was found to lower the risk of death. This suggests that individual clinical details play more significant roles in RCC outcomes than lifestyle factors. Moreover, including MDT discussions in treatment plans may benefit patients. ABSTRACT: Background: The aim was to investigate whether patient-related or clinical risk factors present at the diagnosis of advanced stage renal cell carcinoma (RCC) had an impact on the overall mortality, cancer-specific mortality, and recurrence risk in a national cohort. Methods: Patients registered with stage III and IV RCC in the Danish Renal Cancer Database (DaRenCa) in 2014–2016 were included in the study and followed up until recurrence or death. We conducted a Cox Proportional Hazard Model to examine the association between several variables and the development of RCC. These variables included BMI, hypertension, smoking status, symptoms at diagnosis, performance status, multidisciplinary team (MDT) discussion, surgical margin, and primary metastasis. Separate analyses were performed for cc-RCC and non-ccRCC patients. Results: In our cohort of 929 patients, 424 individuals died from RCC during the follow-up period, with a median follow-up time of 4.1 (95% CI: 0.8–5.0) years for ccRCC and 2.0 (95% CI: 0.1–5.0) years for non-ccRCC. A multivariate analysis demonstrated that a positive surgical margin (HR 1.53 and 1.43), synchronous metastasis (HR 2.06 and 3.23), and poor performance status (HR 4.73 and 5.27) were significantly associated with a decreased 5-year overall and cancer-specific survival, respectively. Furthermore, a positive surgical margin was associated with a higher risk of recurrence in ccRCC. MDT discussion was found to reduce mortality risk in non-ccRCC. Conclusion: Clinical- and disease-related variables have a greater impact on RCC mortality and recurrence than the selected lifestyle-related factors. The inclusion of MDT discussion in the diagnosis and management of advanced RCC should be further evaluated for its potential to improve patient outcomes.