Racial disparities in 3-year cancer-specific and overall survival for metastatic renal cell carcinoma with sarcomatoid features (msRCC): A retrospective analysis from the SEER database (2010-2020).

e16523 Background: msRCC is an aggressive cancer subtype. However, the impact of racial disparities in this population remains underexplored. This study aims to examine racial disparities in 3-year cancer-specific survival (CSS) and overall survival (OS) among patients diagnosed with msRCC. Methods: We retrospectively analyzed the data from the SEER database, including 2,122 patients diagnosed with msRCC between 2010 and 2020. Patients were categorized into racial groups: Non-Hispanic White (NHW), Non-Hispanic Black (NHB), Hispanic, Asian or Pacific Islander (API), and American Indian/Alaska Native (AIAN). 3-year CSS and OS were calculated, and racial differences in survival were assessed using multivariable Cox proportional hazards models, adjusting for demographic, clinical, and treatment variables. Results: NHB patients exhibited the worst 3-year CSS of 9.3% and OS of 8.6%, compared to 23.3% and 20.9% for NHW, 22.1% and 19.0% for Hispanic, 21.2% and 19.4% for API, and 23.4% and 20.7% for AIAN groups, respectively. Multivariable survival analyses revealed that NHB had a50% increased risk (HR=1.5, 95% CI=1.2-1.8, P<0.0001) of CSS and a 40% higher risk (HR=1.4, 95% CI=1.2-1.7) of OS compared NHW. Additionally, Hispanics had a 20% higher risk (HR=1.2, 95% CI=1.0-1.3, P=0.0331) of OS compared NHW. Markedly, the 3-year CSS and OS rates improved across all racial groups from the period of 2010-2015 to 2016-2020. Despite improvement, NHB patients continued to have the lowest rates of 3-year CSS and OS rates during the later period. ln multivariable survival analyses for 2016-2018, NHB patients faced an 80% increased risk (HR=1.8, 95% CI=1.3-2.4, P<0.0001) of CSS and a 60% higher risk (HR=1.6, 95% CI=1.2-2.2) of OS compared to NHW patients. Conclusions: Racial disparities in 3-year CSS and OS persist in msRCC, with NHB patients consistently exhibiting the poorest outcomes, even as survival rates have improved across all racial groups from 2016 to 2020. This improvement was likely contributed by recent advancements in immunotherapy. The underlying reasons for these disparities remain unclear but may involve genetic predisposition, tumor aggressiveness, or socioeconomic factors. Large-scale genetic and molecular studies are needed to uncover biological contributors and guide targeted interventions. Addressing these disparities is critical to advancing equity in msRCC patients.