Diagnosis, treatment, and survival from kidney cancer: real-world National Health Service England data between 2013 and 2019

Samantha Conroy; James W F Catto; Axel Bex; Janet E Brown; Jon Cartledge; Alison Fielding; Rob J Jones; Vincent Khoo; David Nicol; Grant D Stewart; Mark Sullivan; Maxine G B Tran; Rose Woodward; Marcus G Cumberbatch

doi:10.1111/bju.16128

Diagnosis, treatment, and survival from kidney cancer: real-world National Health Service England data between 2013 and 2019

BJU Int. 2023 Nov;132(5):541-553. doi: 10.1111/bju.16128. Epub 2023 Jul 31.

Authors

Samantha Conroy^{1

2}, James W F Catto^{1

2}, Axel Bex^{3

4}, Janet E Brown^{1

5}, Jon Cartledge⁶, Alison Fielding⁷, Rob J Jones⁸, Vincent Khoo^{9

10}, David Nicol^{9

10}, Grant D Stewart¹¹, Mark Sullivan^{12

13}, Maxine G B Tran^{3

4}, Rose Woodward^{14

15}, Marcus G Cumberbatch^{1

2}

Affiliations

¹ Sheffield Teaching Hospitals Foundation Trust, Sheffield, UK.
² Academic Unit of Urology, Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK.
³ Royal Free NHS Foundation Trust, Specialist Centre for Kidney Cancer, London, UK.
⁴ Division of Surgery and Interventional Science, University College London, London, UK.
⁵ Academic Unit of Clinical Oncology, Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK.
⁶ Leeds Teaching Hospitals NHS Trust, Leeds, UK.
⁷ Bladder and Renal Cancer Clinical Studies Group, National Cancer Research Institute, London, UK.
⁸ Institute of Cancer Sciences, University of Glasgow, Glasgow, UK.
⁹ Royal Marsden NHS Foundation Trust, London, UK.
¹⁰ Institute of Cancer Research, London, UK.
¹¹ Department of Surgery, University of Cambridge, Cambridge, UK.
¹² Department of Urology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
¹³ University of Oxford, Oxford, UK.
¹⁴ Action Kidney Cancer, Manchester, UK.
¹⁵ International Kidney Cancer Coalition, UK.

PMID: 37436368
DOI: 10.1111/bju.16128

Abstract

Objectives: To report the NHS Digital (NHSD) data for patients diagnosed with kidney cancer (KC) in England. We explore the incidence, route to diagnosis (RTD), treatment, and survival patterns from 2013 to 2019.

Materials and methods: Data was extracted from the Cancer Data NHSD portal for International Classification of Diseases, 10th edition coded KC; this included Cancer Registry data, Hospital Episode Statistics, and cancer waiting times data.

Results: Registrations included 66 696 individuals with KC. Incidence of new KC diagnoses increased (8998 in 2013, to 10 232 in 2019), but the age-standardised rates were stable (18.7-19.4/100 000 population). Almost half of patients (30 340 [45.5%]) were aged 0-70 years and the cohort were most frequently diagnosed with Stage 1-2 KC (n = 26 297 [39.4%]). Most patients were diagnosed through non-urgent general practitioner referrals (n = 16 814 [30.4%]), followed by 2-week-wait (n = 15 472 [28.0%]) and emergency routes (n = 11 796 [21.3%]), with older patients (aged ≥70 years), Stage 4 KCs, and patients with non-specified renal cell carcinoma being significantly more likely to present through the emergency route (all P < 0.001). Invasive treatment (surgery or ablation), radiotherapy, or systemic anti-cancer therapy use varied with disease stage, patient factors, and treatment network (Cancer Alliance). Survival outcomes differed by Stage, histological subtype, and social deprivation class (P < 0.001). Age-standardised mortality rates did not change over the study duration, although immunotherapy usage is likely not captured in this study timeline.

Conclusion: The NHSD resource provides useful insight about the incidence, diagnostic pathways, treatment, and survival of patients with KC in England and a useful benchmark for the upcoming commissioned National Kidney Cancer Audit. The RTD data may be limited by incidental diagnoses, which could confound the high proportion of 'emergency' diagnoses. Importantly, survival outcomes remained relatively unchanged.

Keywords: chemotherapy; incidence; kidney cancer; prevalence; radical nephrectomy; radiotherapy; renal cancer; stage; surveillance.