22: The impact of insurance status on progression-free survival (PFS) and overall survival (OS) in patients with metastatic renal cell carcinoma (mRCC)

Background: Insurance status has been shown to serve as a prognostic factor associated with
OS in patients with RCC (Zhang et al., Future Oncol 2019). Herein we explored the impact of
primary and secondary insurance status on PFS and OS in patients receiving first-line systemic
therapy for mRCC.

Methods: Patients diagnosed with mRCC between 1990 and 2022 with available insurance
information were retrospectively identified using institutional databases from two NCI-
designated cancer centers. Primary insurance information was categorized into three
groups—Medicare, private insurance, and Medicaid/no insurance—while secondary insurance
was defined by the presence or absence of secondary coverage. PFS and OS were estimated
by Kaplan-Meier method and compared based on insurance status using log-rank tests.
Multivariate Cox models were used to examine the impact of insurance status on PFS and OS.

Results: Of the 645 patients included in our analysis, 344 (53.3%), 250 (38.8%), and 51 (7.9%)
had primary Medicare, private insurance, and Medicaid/no insurance, respectively. Median
survival outcomes for patients by primary and secondary insurance status varied (Table 1).
Specifically, by log-rank test, a significant difference in PFS among the primary insurance
groups was observed (p<0.0001). When adjusting for potential confounders, patients with
secondary insurance showed improved PFS over those without (p=0.0281). Furthermore, a log-
rank test revealed a significant difference in OS by primary insurance type (p=0.0003). No
statistically significant differences in OS were observed based on secondary insurance status.

Conclusions: Patients with primary Medicaid/no insurance or private insurance had inferior
median PFS and OS compared to those with primary Medicare. Patients with secondary
insurance had superior PFS over those with primary insurance alone. Our findings suggest that
insurance status may impact clinical outcomes and warrant external validation in prospective
studies.