Survival and treatment of stage IV renal cell carcinoma in academic vs non-academic medical centers

Table 1 5-year and 10-year overall survival

Variable (n = 79367)	Academic (n = 30780)	Non-academic (n = 48587)	P value
5-year OS (%)	17.0	11.5	< 0.05
10-year OS (%)	9.20	5.50	< 0.05

OS: Overall survival.

Table 2 Demographic, socioeconomic, and clinical characteristics of patients with metastatic renal cell carcinoma, n (%)

Variable (n = 79367)	Academic facility (n = 30780)	Non-academic facility (n = 48587)	P value
Age [mean (SD)]	63.8 (10.9)	66.6 (11.4)	< 0.05
Distance travelled [mean (SD)]	57.6 (136)	23.8 (86.7)	< 0.05
Sex			0.511
Male	21428 (69.6)	32637 (67.2)
Female	9352 (30.4)	15950 (32.8)
Insurance status			< 0.05
Race			< 0.05
White	42600 (88.4)	25591 (84.1)
Black	4160 (8.6)	3473 (11.4)
Other	1441 (3.0)	1363 (4.5)
Race-missing data	739
Private insurance	11954 (40.7)	16790 (35.9)
Medicaid	2747 (9.4)	3120 (6.7)
Medicare	12744 (43.4)	25470 (54.5)
Other government	482 (1.6)	707 (1.5)
Insurance Status unknown	1418 (4.8)	653 (1.4)
Income class			< 0.05
< $38000	3666 (11.9)	5495 (11.3)
$38000-$47999	5422 (17.6)	7993 (16.5)
$48000-$62999	6032 (19.6)	10782 (22.2)
> $63000	9327 (30.3)	1317 (27.1)
Urban/Rural			< 0.05
Metro area greater than 1 million people	15886 (51.6)	21670 (44.6)
Metro area 250000–1 million	5856 (19.0)	10980 (22.6)
Metro area < 250000	9038 (29.4)	15937 (32.8)
Tumor size [mean (SD)]	481 (450)	469 (453)	< 0.05
Facility location			< 0.05
New England	2322 (4.8)	1496 (4.9)
Middle Atlantic	4540 (9.3)	6164 (20.0)
South Atlantic	10448 (21.5)	5796 (18.8)
East North Central	8959 (18.4)	4851 (15.8)
East South Central	3883 (8.0)	1758 (9.6)
West North Central	4211 (8.7)	2955 (12.3)
West South Central	5186 (10.7)	3793 (12.3)
Mountain	2189 (5.8)	859 (2.8)
Pacific	6219 (12.8)	3108 (10.1)
Regional lymph nodes positive	77.6 (39.4)	85.7 (32.2)	< 0.05
Charleson-deyo score			< 0.05
0	22077 (71.4)	32286 (66.4)
1	5638 (18.3)	10001 (20.6)
2	1784 (5.8)	3715 (7.6)
3	1281 (4.2)	2585 (5.3)

Table 3 Treatment characteristics of patients with metastatic renal cell carcinoma, n (%)

Variable (n = 1068)	Academic (n = 30780)	Non-academic (n = 48587)	P value
Definitive surgical procedure, days from Dx [mean (SD)]	43.1 (63.7)	37.5 (61.5)	< 0.05
Systemic therapy initiated, days from Dx [mean (SD)]	64.5 (57.1)	55.8 (54.2)	< 0.05
Chemotherapy initiated, days from Dx [mean (SD)]	64.9 (61.3)	56.2 (54.9)	< 0.05
Radiation therapy initiated, days from Dx [mean (SD)]	56.1 (76.8)	45.8 (61.6)	< 0.05
Immunotherapy initiated, days from Dx [mean (SD)]	75.6 (65.9)	67.5 (72.9)	< 0.05
Surgical inpatient stay [mean (SD)]	5.64 (7.46)	5.40 (6.92)	0.006
Surgery of primary site			< 0.05
Subtotal nephrectomy	624 (2.0)	612 (1.3)
Complete nephrectomy	876 (2.8)	1417 (2.9)
Radical nephrectomy	11,419 (37.1)	13382 (27.5)
Surgery, other	1,015 (3.3)	1052 (2.2)
Surgery of primary site not performed	16,846 (54.7)	32124 (66.1)
Adjuvant therapy			< 0.05
Adjuvant chemoradiation	65 (0.2)	190 (0.4)
Adjuvant radiation	412 (1.3)	514 (1.1)
Adjuvant chemotherapy	1350 (4.4)	1779 (3.7)
No adjuvant therapy	28953 (94.1)	46104 (94.9)
Immunotherapy			< 0.05
Received immunotherapy	5264 (17.1)	6864 (14.1)
Did not receive immunotherapy	25132 (81.7)	41075 (84.5)
Unknown if received immunotherapy	384 (1.2)	648 (1.3)

Table 4 Multivariate regression models for association of non-academic facility type with poor survival outcomes

Variables	Odds ratio/HR	95%CI	P value
Crude model (unadjusted)	1.34	1.30-1.40	< 0.05
Model adjusted for age, tumor size, sex, and distance travelled	1.23	1.18-1.28	< 0.05
Cox proportional model for HR (unadjusted)	1.27	1.24-1.29	< 0.05

Reference predictor: Academic facility type. Reference outcome: Living status. HR: Hazard ratio.