Objective: Renal cell carcinoma (RCC) is a rare but severe and aggressive pediatric malignancy. While incidence is uncommon, survival is relatively low with respect to acute lymphocytic leukemia (ALL), AML, lymphoma, ependymoma, glioblastoma, and Wilms Tumor. The pediatric renal cell carcinoma (pRCC) incidence, cumulative incidence (period prevalence), and mortality vary by health disparities’ indicators, namely sex, race, ethnicity, age at tumor diagnosis, and social determinants of health (SDHs) as well as Epigenomic Determinants of Health (EDHs). However, studies are unavailable on some pRCC risk determinants, such as area of residence and socio-economic status (SES). The current study aimed at assessing the temporal trends, cumulative incidence, household median income, urbanity, mortality, and pRCC survival differentials. Materials and Methods: A retrospective cohort design was utilized to examine the event-free survival of children (0–19) with RCC using the Surveillance Epidemiology and End Result Data, 1973–2015. While the time-dependent variable, namely survival months, was utilized, we assessed the predictors of pRCC survival, mainly sex, age at diagnosis, education, insurance status, income, and tumor grade, as prognostic factors. In examining the joint effect of area of residence and race, as an exposure function with time in survival, we utilized the Cox proportional hazard model, while the annual percent change was assessed using a generalized linear model, implying a weighted average. Results: Between 1973 and 2015, there were 174 cases of pRCC, of whom 49 experienced mortality (28.2%). The pRCC cumulative incidence tends to increase with advancing age. A significant survival differential was observed between black/AA children with RCC and their white counterparts. Compared with white children, black/AA children were almost three times as likely to die, hazard ratio (HR) = 2.90, 95% CI = 1.56–5.31,p= 0.001. A survival differential was observed in sex, with males presenting with a 21% increased likelihood of dying, HR = 1.21; 95% CI, 0.69–2.11. In the metropolitan area, the risk of dying was almost three times as likely among black/AA children compared to their white counterparts, HR = 2.78; 95% CI, 1.45–5.43, while in the urban area, the risk of dying was almost four times as likely among black/AA children compared to their white counterparts, HR = 4.18; 95% CI, 0.84–20.80. After controlling for age, sex, education, and insurance, the risk of dying increased amongst black/AA children in metropolitan areas, adjusted HR (aHR) = 3.37, 99% CI = 1.35–8.44. In the urban area, after adjustment for age, sex, and insurance, there was an increased risk of dying for black/AA children, compared with their white counterparts with pRCC, aHR = 8.87, 99% CI = 2.77–28.10. Conclusion: pRCC indicates an increased trend in males and age at diagnosis between 10 and 14, as well as a survival disadvantage among black/AA children, compared with their white counterparts. Additionally, urbanity significantly influences the racial differences in survival. These data are suggestive of the conjoined effect of environment and race in pRCC survival, indicative of further assessment of gene–environment interaction (epigenomics) in incidence, mortality, and survival in pRCC.
目的：肾细胞癌（RCC）是一种罕见但严重且具有侵袭性的儿童恶性肿瘤。尽管发病率不高，但与急性淋巴细胞白血病（ALL）、急性髓系白血病（AML）、淋巴瘤、室管膜瘤、胶质母细胞瘤和肾母细胞瘤相比，其生存率相对较低。儿童肾细胞癌（pRCC）的发病率、累积发病率（期间患病率）和死亡率因健康差异指标而异，这些指标包括性别、种族、民族、肿瘤诊断年龄、健康的社会决定因素（SDHs）以及健康的表观基因组决定因素（EDHs）。然而，目前缺乏关于某些pRCC风险决定因素的研究，例如居住地区和社会经济地位（SES）。本研究旨在评估pRCC的时间趋势、累积发病率、家庭收入中位数、城市化程度、死亡率以及生存差异。材料与方法：采用回顾性队列设计，利用1973年至2015年的监测、流行病学和最终结果数据，研究0-19岁RCC患儿的无事件生存期。在利用时间依赖变量（即生存月数）的同时，我们评估了pRCC生存的预测因素，主要包括性别、诊断年龄、教育程度、保险状况、收入和肿瘤分级作为预后因素。在考察居住地区与种族的联合效应（作为生存时间中的暴露函数）时，我们采用了Cox比例风险模型，而年度百分比变化则通过广义线性模型进行评估，这意味着采用了加权平均值。结果：1973年至2015年间，共有174例pRCC病例，其中49例死亡（28.2%）。pRCC的累积发病率随年龄增长呈上升趋势。在患有RCC的黑人/非裔美国儿童与白人儿童之间观察到显著的生存差异。与白人儿童相比，黑人/非裔美国儿童的死亡风险高出近三倍，风险比（HR）= 2.90，95% CI = 1.56–5.31，p= 0.001。性别间也存在生存差异，男性死亡可能性增加21%，HR = 1.21；95% CI，0.69–2.11。在大都市区，黑人/非裔美国儿童的死亡风险几乎是白人儿童的近三倍，HR = 2.78；95% CI，1.45–5.43；而在城市地区，黑人/非裔美国儿童的死亡风险几乎是白人儿童的近四倍，HR = 4.18；95% CI，0.84–20.80。在控制年龄、性别、教育和保险因素后，大都市区黑人/非裔美国儿童的死亡风险增加，调整后风险比（aHR）= 3.37，99% CI = 1.35–8.44。在城市地区，调整年龄、性别和保险因素后，与患有pRCC的白人儿童相比，黑人/非裔美国儿童的死亡风险增加，aHR = 8.87，99% CI = 2.77–28.10。结论：pRCC在男性和10至14岁诊断年龄组中呈上升趋势，且与白人儿童相比，黑人/非裔美国儿童的生存处于劣势。此外，城市化程度显著影响生存的种族差异。这些数据表明环境和种族对pRCC生存存在联合影响，提示需进一步评估基因-环境交互作用（表观基因组学）在pRCC发病率、死亡率和生存中的作用。
肿瘤(癌症)患者之家