Retrospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Nephrol. Jun 25, 2025; 14(2): 103923
Published online Jun 25, 2025. doi: 10.5527/wjn.v14.i2.103923
Survival and treatment of stage IV renal cell carcinoma in academic vs non-academic medical centers
Bob Weng, Marco Braaten, Jenna Lehn, Reid Morrissey, Muhammad Sohaib Asghar, Peter Silberstein, Ali Bin Abdul Jabbar, Abraham Mathews, Abubakar Tauseef, Mohsin Mirza
Bob Weng, Marco Braaten, Jenna Lehn, Reid Morrissey, Peter Silberstein, Ali Bin Abdul Jabbar, Abraham Mathews, Abubakar Tauseef, Mohsin Mirza, Department of Internal Medicine, Creighton University School of Medicine, Omaha, NE 68178, United States
Muhammad Sohaib Asghar, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, United States
Co-corresponding authors: Bob Weng and Marco Braaten.
Author contributions: Weng B and Braaten M participated in the conception, design, analysis, interpretation, writing, and revision of the manuscript; Lehn J and Morrissey R participated in the writing and revision of the manuscript; Asghar MS, Silberstein P, Abdul Jabbar AB, Mathews A, Abubakar T, and Mirza M assessed and verified the study design and data; Weng B, Braaten M, Lehn J, Morrissey R, Asghar MS, Silberstein P, Abdul Jabbar AB, Mathews A, Tauseef A, and Mirza M reviewed and approved of the manuscript; all authors were responsible for the decision to submit the manuscript for publication.
Institutional review board statement: This investigation was not applicable for institutional review as it is a retrospective deidentified study.
Informed consent statement: This investigation was not applicable for informed consent as it is a retrospective deidentified study.
Conflict-of-interest statement: No conflict of interests disclosed for any authors.
Data sharing statement: No additional data are available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Bob Weng, Department of Internal Medicine, Creighton University School of Medicine, CL and Rachel Werner Center for Health Sciences Education 2616 Burt Street, Omaha, NE 68178, United States. bobweng@creighton.edu
Received: December 9, 2024
Revised: January 22, 2025
Accepted: February 8, 2025
Published online: June 25, 2025
Processing time: 124 Days and 13 Hours
Abstract
BACKGROUND

Renal cell carcinoma (RCC) is treated with surgical resection as the gold standard, as it is notoriously resistant to systemic therapy. Advancements with targeted therapies contribute to declining mortality, but metastatic RCC (mRCC) survival remains poor. One possible factor is treatment at academic centers, which employ advanced providers and novel therapies. This study compared outcomes of mRCC in patients treated at academic/research facilities compared to those treated at non-academic centers.

AIM

To compare survival outcomes of mRCC and their various etiologies between academic and non-academic centers.

METHODS

The National Cancer Database was used to identify mRCC patients including all histology subtypes and stage IV disease. Descriptive statistics and Kaplan-Meier curves measured survival outcomes for user file facility types sorted into a binary academic/research and non-academic research variable. Multivariate logistic regression and Cox proportional hazard testing generated odds ratio and hazard ratio. Data was analyzed using Statistical Package for the Social Sciences version 29.0 using a significance level of P < 0.05.

RESULTS

Overall, academic facility patients experienced greater 5-year and 10-year overall survival than non-academic facility patients. Treatment at non-academic facilities was associated with increased odds of death that persisted even after controlling for age, tumor size, sex, and distance traveled to treatment center. In comparison, non-academic facility patients also experienced greater risk of hazard.

CONCLUSION

Patients with mRCC treated at academic/research facilities experienced increased survival compared to patients treated at non-academic facilities, were more likely to be younger, carry private insurance, and come from a large metropolitan area. They also were significantly more likely to receive surgery and adjuvant immunotherapy.

Keywords: Renal cell carcinoma; Academic; Non-academic; Facility; Center; Type; Survival; Outcome

Core Tip: Treatment of renal cell carcinoma (RCC) has been historically challenging. Our objective is to explore the contextual factors influencing RCC patients and their outcomes, primarily between those receiving care at academic compared to non-academic institutions. Previous studies on other cancers have some but limited insight into the remarkable discrepancy in survival in favor of academic centers. We aim to elucidate these findings for RCC using the National Cancer Database which unprecedentedly now enables analyzing large numbers of patients across long spans of time.