Incidence, Prognostic Factors, and Survival of Patients with Renal Cancer: A Population-Based Study

Figures & data

Figure 1. Research flow chart.

Figure 2. Incidence of kidney cancer. (A) Overall incidence, (B) Sex-based incidence, (C) Distant metastasis-based incidence, and (D) Race-based incidence (AIAN: American Indian/Alaska Native; API: Asian or Pacific Islander).

Figure 3. Correlation of different clinical variables with OS. (A) Age, (B) Sex, (C) Race, (D) AJCC-Stage, (E) Histological type, (F) Surgery, (G) Marital status, and (H) Insurance status (AIAN: American Indian/Alaska Native; API: Asian or Pacific Islander; RCC: renal cell carcinoma; Spcc: spindle cell carcinoma; Edc: renal endocrine tumor; Sqcc: squamous cell carcinoma; Oet: other types of renal epithelial tumors; Npb: nephroblastoma; NS: no surgery; LTE: local tumor excision; PN: partial nephrectomy; RN: radical nephrectomy).

Table 2. Univariate and multivariate Cox regression analyses of risk factors for renal cancer patients.

Factors	Univariate analysis		Multivariate analysis
	HR (95% CI)	p value	HR (95% CI)	p value
Gender
Male	Reference		Reference
Female	0.869 (0.841 − 0.898)	<0.05	0.846 (0.817 − 0.875)	<0.05
Age (years)
0–50	Reference		Reference	<0.05
51–60	1.708 (1.601 − 1.822)	<0.05	1.378 (1.291 − 1.470)	<0.05
61–70	2.168 (2.040 − 2.304)	<0.05	1.767 (1.660 − 1.880)	<0.05
71–80	3.246 (3.052 − 3.452)	<0.05	2.381 (2.233 − 2.538)	<0.05
>81	6.736 (6.315 − 7.185)	<0.05	3.382 (3.151 − 3.630)	<0.05
Histologic Type
Rcc	Reference		Reference	<0.05
Sqcc	4.261 (3.869 − 4.693)	<0.05	1.838 (1.665 − 2.029)	<0.05
Edc	2.661 (1.881 − 3.764)	<0.05	1.025 (0.724 − 1.452)	0.89
Spcc	2.804 (1.508 − 5.213)	<0.05	1.411 (0.759 − 2.625)	0.277
Oet	5.712 (5.252 − 6.211)	<0.05	1.471 (1.350 − 1.603)	<0.05
Race
White	Reference		Reference
Black	1.001 (0.955 − 1.049)	0.973	–	–
API	0.939 (0.875 − 1.009)	0.086	–	–
AIAN	1.115 (0.959 − 1.297)	0.156	–	–
TNM–T
T0	Reference		Reference
T1	0.076 (0.062 − 0.094)	<0.05	0.998 (0.804 − 1.238)	0.983
T2	0.176 (0.142 − 0.218)	<0.05	1.155 (0.93 − 1.435)	0.193
T3	0.214 (0.173 − 0.265)	<0.05	1.328 (1.072 − 1.646)	<0.05
T4	0.877 (0.707 − 1.088)	0.233	1.334 (1.071 − 1.662)	<0.05
TNM–N
N0	Reference		Reference
N1	8.593 (8.257 − 8.943)	<0.05	1.765 (1.685 − 1.849)	<0.05
N2	17.855 (2.515 − 126.781)	<0.05	3.791 (0.531 − 27.054)	0.184
TNM–M
M0	Reference		Reference
M1	10.699 (10.353 − 11.056)	<0.05	1.068 (0.936 − 1.217)	0.33
AJCC Stage
I	Reference		Reference
II	1.444 (1.354 − 1.539)	<0.05	1.208 (1.094 − 1.334)	<0.05
III	2.276 (2.177 − 2.379)	<0.05	1.588 (1.471 − 1.715)	<0.05
IV	13.299 (12.828 − 13.787)	<0.05	3.802 (3.318 − 4.356)	<0.05
Surgery
NS	Reference		Reference
LTS	0.130 (0.120 − 0.141)	<0.05	0.325 (0.299 − 0.353)	<0.05
PN	0.053 (0.050 − 0.056)	<0.05	0.158 (0.148 − 0.168)	<0.05
RN	0.178 (0.172 − 0.184)	<0.05	0.318 (0.305 − 0.332)	<0.05
Tumor metastasis
Bone
No	Reference		Reference
Yes	8.539 (8.168 − 8.928)	<0.05	1.149 (1.089 − 1.212)	<0.05
Brain
No	Reference		Reference
Yes	9.837 (9.126 − 10.603)	<0.05	1.449 (1.34 − 1.567)	<0.05
Liver
No	Reference		Reference
Yes	11.995 (11.341 − 12.687)	<0.05	1.414 (1.330 − 1.504)	<0.05
Lung
No	Reference		Reference
Yes	9.867 (9.503 − 10.245)	<0.05	1.238 (1.173 − 1.307)	<0.05
Marital status
Married	Reference		Reference
Separated	1.287 (1.124 − 1.474)	<0.05	1.588 (1.386 − 1.819)	<0.05
Divorced	1.296 (1.231 − 1.364)	<0.05	1.305 (1.240 − 1.375)	<0.05
Widowed	2.264 (2.170 − 2.362)	<0.05	1.414 (1.348 − 1.483)	<0.05
Unmarried	1.137 (1.088 − 1.187)	<0.05	1.270 (1.214 − 1.327)	<0.05
Insurance
Insured	Reference		Reference
Uninsured	0.971 (0.895 − 1.053)	0.475	–	–

AIAN: American Indian/Alaska Native; API: Asian or Pacific Islander; RCC: renal cell carcinoma; Spcc: spindle cell carcinoma; Edc: renal endocrine tumor; Sqcc: squamous cell carcinoma; Oet: other types of renal epithelial tumors; Npb: nephroblastoma; NS: no surgery; LTS: local tumor excision; PN: partial nephrectomy; RN: radical nephrectomy.

Figure 4. (A) Predicted 1-, 3-, and 5-year prognosis nomogram. (B) Calibration curves (AIAN: American Indian/Alaska Native; API: Asian or Pacific Islander; RCC: renal cell carcinoma; Spcc: spindle cell carcinoma; Edc: renal endocrine tumor; Sqcc: squamous cell carcinoma; Oet: other types of renal epithelial tumors; NS: no surgery; LTE: local tumor excision; PN: partial nephrectomy; RN: radical nephrectomy) (since there were only 2 Npb patients, they were not included).

Table 1. Baseline characteristics of included patients.

Factors	N	Percentage	Age (mean ± SD)
Total	68496	100%	62.64 ± 13.007
Gender
Male	43797	63.941%	62.45 ± 12.614
Female	24699	36.059%	62.98 ± 13.671
Age (years)
0–50	11882	17.347%	42.62 ± 6.686
51–60	16821	24.558%	55.92 ± 2.828
61–70	20672	30.180%	65.47 ± 2.799
71–80	13462	19.654%	74.93 ± 2.819
>81	5659	8.262%	85.11 ± 3.720
Histologic type
Rcc	66972	97.775%	62.44 ± 12.917
Sqcc	650	0.949%	71.34 ± 12.228
Edc	62	0.091%	63.47 ± 18.095
Npb	2	0.003%	20.00 ± 25.456
Spcc	23	0.034%	63.78 ± 15.442
Oet	787	1.149%	72.47 ± 14.271
Race
White	56005	81.764%	63.01 ± 13.042
Black	8249	12.043%	60.59 ± 12.449
API	3602	5.259%	62.20 ± 13.339
AIAN	640	0.934%	59.42 ± 12.187
Year of diagnosis
2010	10408	15.195%	62.56 ± 13.139
2011	10714	15.642%	62.44 ± 13.051
2012	11277	16.464%	62.57 ± 12.965
2013	11512	16.807%	62.81 ± 13.085
2014	11949	17.445%	62.77 ± 12.949
2015	12636	18.448%	62.68 ± 12.882
TNM–T
T0	102	0.149%	67.20 ± 13.006
T1	46780	68.296%	62.30 ± 13.174
T2	7392	10.792%	61.96 ± 13.292
T3	12554	18.328%	63.97 ± 12.05
T4	1668	2.435%	64.91 ± 13.036
TNM-N
N0	64630	94.356%	62.58 ± 12.962
N1	3865	5.643%	63.73 ± 13.699
N2	1	0.001%	65.00 ± 0.000
TNM-M
M0	60991	89.043%	62.35 ± 13.023
M1	7505	10.957%	64.98 ± 12.644
AJCC stage
I	44771	65.363%	62.03 ± 13.104
II	5678	8.290%	61.19 ± 13.213
III	10013	14.618%	64.22 ± 12.313
IV	8034	11.729%	65.12 ± 12.671
Surgery
NS	10403	15.188%	70.50 ± 13.234
LTS	3939	5.751%	67.58 ± 11.643
PN	21770	31.783%	59.12 ± 12.311
RN	32384	47.279%	61.89 ± 12.311
Tumor metastasis
Bone	2819	4.116%	64.95 ± 12.502
Brain	828	1.209%	62.88 ± 11.209
Liver	1531	2.235%	65.38 ± 13.08
Lung	4518	6.596%	64.52 ± 12.416
Marital status
Married	42938	62.687%	62.65 ± 12.081
Separated	821	1.199%	58.13 ± 11.888
Divorced	6641	9.695%	61.68 ± 10.935
Widowed	6680	9.752%	75.18 ± 10.234
Unmarried	11416	16.667%	56.15 ± 13.754
Insurance
Insured	2497	3.645%	55.18 ± 12.345
Uninsured	65999	96.355%	62.92 ± 12.948

AIAN: American Indian/Alaska Native; API: Asian or Pacific Islander; RCC: renal cell carcinoma; Spcc: spindle cell carcinoma; Edc: renal endocrine tumor; Sqcc: squamous cell carcinoma; Oet: other types of renal epithelial tumors; Npb: nephroblastoma; NS: no surgery; LTS: local tumor excision; PN: partial nephrectomy; RN: radical nephrectomy.