ABSTRACT
Kidney cancer (KC) is a not very common neoplasm and has a good overall survival rate, especially for early forms. In this study we investigated, in a real-world context, the impact of stage and treatment on KC outcomes, particularly in patients with prior cardiovascular disease (CVD). Analyzing data from the Reggio Emilia Cancer Registry spanning 2003 to 2018, we examined 1,566 kidney cancer patients and 1,124 long-living patients.
By comparing patients between 2003-2010 and 2011-2018 (target therapies were introduced in 2011), we aimed to assess any improvements in survival rates. Multivariable analysis shows an increased risk of death related to age (40-59 years [HR 2.97; 95% CI 1.21-7.31], 60-79 years [HR 6.90; 2-84-16-79], 80+ [ HR 19.55; 95% CI 7.99-47.84]), and recent hospitalization for CVD [HR 1.76; 95% CI 1.24-2.51] while the risk is reduced in the more recent period [HR 0.78; 95% CI 0.67-0.91]. This reduction is linked partly to the increase in stage I recorded between the first and second periods (40.7% vs. 54.6%) and partly to the administration of Target Therapy to all patients with advanced disease in the second period.
The study highlights that in addition to early diagnosis and innovative treatments, multidisciplinary cardio-oncological management of patients with kidney cancer is essential.

IMPACT STATEMENT
Kidney cancer has a good prognosis and, with targeted therapies, profoundly changes treatment approaches. This study evaluates mortality and survival in a province in Northern Italy where the introduction of targeted therapy in 2011 seems to have changed the prognosis of kidney cancer. We have seen a decline in mortality that appears to be related to both the decline in advanced forms and the introduction of new drugs.