Trends in incidence and mortality in kidney cancer patients over the last 25 years in Reggio Emilia Province of the North Italy.
Authors: Di Girolamo Stefania , Masini Cristina , Mangone Lucia , Marinelli Francesco , Bisceglia Isabella , Tarantini Luigi , Navazio Alessandro , Pinto Carmine 
Published: June 2022

e22511 Background: In the last years, the incidence of renal cell carcinoma (RCC) has rapidly increased in Western countries. From the first decade of this century the new drugs (tyrosine kinase inhibitors, immune checkpoint inhibitors) have markedly improved the clinical outcomes of these patients (pts). The increase in survival has allowed to observe the emergence of other illness including cardiovascular disease (CVD). The aim of our study is to examine the trend in incidence and mortality for tumors and for CVD in RCC pts of Reggio Emilia Province. Methods: All cases of RCC recorded from 1996 to 2020 in Reggio Emilia Cancer Registry (RE-CR) were included. The RE-CR covers a population of 529,609 inhabitants. It is considered a high-quality CR thanks high histological confirmation and data updated to 2020. Kidney cancer cases were defined based on the ICD-O-3 as topography C64.9. The causes of death were classified as kidney cancer, other cancers, CVD (ICD-10 I00-I99). Mortality data were selected based on classification C64 used in the ICD-O-10. Descriptive analyses of patient characteristics with kidney cancer were performed by number of deaths for all causes, for CVD, for kidney cancer and for other cancer. For difference within these groups, we performed one-way Anova test. Analyses were performed using STATA 16.1 software. Trends over time were analyzed by calculating the annual percent change (APC) in age-standardized rates using Joinpoint regression. Results: 2,331 pts with RCC were identified, mainly males (1,504 cases) and aged 60-79 years (1,240 cases). There were 1,257 deaths, with no differences by sex but with a significant gradient according to age (12.1% among young people and 80.4% among over 80 years). The standardized incidence rate showed an increase in males between 1996 and 2011 (APC = 2.3) and then decreased. In females the trend appeared stable. Mortality dropped significantly among those who received diagnosis in the recent years (79.4% in 1996-2000 vs 25.2% in 2016-2020). The standardized mortality rate decreased both in males (APC = -3.3%) and in females (APC = -4.5%). Comparing the same periods, kidney cancer specific mortality decreased from 81.8% to 43.7% (p < 0.01). The opposite occurred for CVD mortality with an increasing not-statistically significant trend. The risk of CVD mortality increased as we move away from the diagnosis (from 6.2% to 27.5%, p < 0.01). The same trend was observed for other causes of death (from 12.6% to 32.1%, p < 0.01). Conclusions: The percentage of mortality from RCC has decreased over the years, while that from CVD has slightly increased starting from 2009. These data may be related to the introduction of new active therapies with a significantly reduction in mortality in the first two years from diagnosis and a longer survival. Dedicated studies are required to define the impact of cancer treatment on CVD risk in long-term cancer survivors.