MIAMI BEACH, FL – Cancer-specific outcomes have been significantly improved by therapies treating advanced renal cell carcinoma (RCC) with distant metastasis. Those patients remain at increased risk of cardiovascular disease (CVD) and related events, however.
A new study published in Cancer Epidemiology sought to investigate the trend of incidence-based mortality specific to CVD in patients with metastatic RCC. Researchers from Columbia University Division of Cardiology at Mount Sinai Medical Center in Miami Beach, FL, examined data from 26,501 adult patients aged 18 and older diagnosed with metastatic RCC between 2005 and 2020 in the Surveillance, Epidemiology, and End Results (SEER) 17 registry. The Salem, VA, VAMC participated in the study.1
The study team used a linear regression model to examine trends in metastatic RCC incidence and mortality rates among the U.S. general population stratified by gender.
Results indicated that, among 26,501 adult patients diagnosed with metastatic RCC, RCC-specific mortality accounted for 18,258 (81.1 %) of deaths, while mortality due to cardiovascular (CV) events was 737 (3.3 %).
The study group included 18,139 (68.4 %) males and 8362 (31.6 %) females. Among all patients included, 22,507 (85 %) patients died of any cause (all-cause). There were 15,213 (67.6 %) deaths among males and 7294 (32.4 %) females.
“The overall incidence rate of metastatic RCC increased over time (p-value < 0.001),” the authors pointed out. “A significant interaction between time and sex was found, indicating greater increase in metastatic RCC incidence rates in males than females over time (p < 0.001 for interaction). There was no statistically significant difference in metastatic RCC-specific mortality rate between sexes (p = 0.25) or over time (p = 0.89).”
They added that the combined CV mortality rate (in both sexes) increased from 0.02 to 0.04 from 2005–2020 and was statistically significant (p = 0.001) with no significant difference in mortality between sexes, adding, “The trend of increasing metastatic RCC incidence with no change in all cause and metastatic RCC specific mortality would suggest benefit of advances in therapy. However, the slow but gradual rise in CV mortality needs to be further studied. Keywords: advanced renal cell carcinoma, cardiovascular mortality, sex.”
Background information in the article noted that renal cell carcinoma (RCC) is the most common primary kidney tumor whose incidence has been increasing in the United States ) with a higher prevalence in males.
“Metastatic RCC refers to RCC that has metastasized to distant organs or systems, commonly affecting the lungs, liver, bone, and brain,” according to the researchers. “Treatment for metastatic RCC typically involves therapies targeting cytokines, vascular endothelial growth factor (VEGF), platelet-derived growth factors (PDGF), mammalian target of rapamycin (mTOR), immune checkpoints (PD-1, CTLA-4), and most recently, hypoxia-inducible factor-2 alpha (HIF-2α).”
The study pointed out that, while localized RCC can be effectively treated with surgery or other therapies, metastatic RCC “carries a poorer prognosis and higher mortality rate. Patients with metastatic RCC are at a heightened risk of developing cardiovascular disease (CVD), with some studies indicating a two-fold increased risk of cardiovascular (CV) events
The authors said they embarked on the study because of limited research on the trends of cardiovascular mortality in metastatic RCC.
“In this analysis of 26,501 patients with metastatic RCC in SEER, we found a statistically significant and gradual increase in CV deaths among patients with metastatic RCC from 2005 to 2020 (p-value for trend < 0.001),” the researchers advised. “This slow but gradual increase in CV deaths from 2005 to 2020 correlates with the advances in the management of metastatic RCC with newer cancer therapies .”
- Baral N, Deych E, Chandramohan D, Kunadi A, Elajami TK, Karki NR, Prasai A, Ladin DA, Gautam A, Khanal R, Beohar N, Mitchell JD. Trend of cardiovascular mortality among metastatic renal cell cancer patients in the US from 2005 to 2020. Cancer Epidemiol. 2025 Apr;95:102758. doi: 10.1016/j.canep.2025.102758. Epub 2025 Jan 30. PMID: 39889311.
