Impact of Time to Surgery and Surgical Delay on Oncologic Outcomes for Renal Cell Carcinoma
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Abstract
Purpose:
The time between radiographic identification of a renal tumor and surgery can be concerning for patients and clinicians due to fears of tumor progression while awaiting treatment. This study aimed to evaluate the association between surgical wait time and oncologic outcomes for patients with renal cell carcinoma.
Materials and Methods:
The Canadian Kidney Cancer Information System is a multi-institutional prospective cohort initiated in January 2011. Patients with clinical stage T1b or greater renal cell carcinoma diagnosed between January 2011 and December 2019 were included in this analysis. Outcomes of interest were pathological up staging, cancer recurrence, cancer specific survival and overall survival. Time to recurrence and death were estimated using Kaplan-Meier estimates and associations were determined using Cox proportional hazards models.
Results:
A total of 1,769 patients satisfied the study criteria. Median wait times were 54 days (IQR 29–86) for the overall cohort and 81 days (IQR 49–127) for cT1b tumors (1,166 patients), 45 days (IQR 27–71) for cT2 tumors (672 cases) and 35 days (IQR 18–61) for cT3/4 tumors (563). Adjusting for comorbidity, tumor size, grade, histological subtype, margin status and pathological stage, there was no association between prolonged wait time and cancer recurrence or death.
Conclusions:
In the context of current surgeon triaging practices surgical wait times up to 24 weeks were not associated with adverse oncologic outcomes after 2 years of followup.
References
- 1. United States Census Bureau: An Aging Nation: Projected Number of Children and Older Adults. United States Census Bureau. 2017. Available at https://www.census.gov/library/visualizations/2018/comm/historic-first.html. Accessed April 16, 2019. Google Scholar
- 2. : Wait times for cancer surgery in the United States: trends and predictors of delays. Ann Surg 2011; 253: 779. Google Scholar
- 3. : An interval longer than 12 weeks between the diagnosis of muscle invasion and cystectomy is associated with worse outcome in bladder carcinoma. J Urol 2003; 169: 110. Link, Google Scholar
- 4. : Cystectomy delay more than 3 months from initial bladder cancer diagnosis results in decreased disease specific and overall survival. J Urol 2006; 175: 1262. Link, Google Scholar
- 5. : Mortality increases when radical cystectomy is delayed more than 12 weeks. Cancer 2009; 115: 988. Google Scholar
- 6. : Longer wait times increase overall mortality in patients with bladder cancer. J Urol 2009; 182: 1318. Link, Google Scholar
- 7. : Influence of delays to nonemergent colon cancer surgery on operative mortality, disease-specific survival and overall survival. Can J Surg 2009; 52: E79. Google Scholar
- 8. : Immediate versus delayed prostatectomy: nationwide population-based study. Scand J Urol 2016; 50: 246. Google Scholar
- 9. : Comparison of pathological outcomes for men with low risk prostate cancer from diverse practice settings: similar results from immediate prostatectomy or initial surveillance with delayed prostatectomy. J Urol 2016; 196: 1415. Link, Google Scholar
- 10. : Surveillance of small renal masses. Urology 2016; 98: 8. Google Scholar
- 11. : Management of small renal masses: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol 2017; 35: 668. Google Scholar
- 12. : Active surveillance in small renal masses in the elderly: a literature review. Eur Urol Focus 2017; 3: 340. Google Scholar
- 13. : Waiting time from initial urological consultation to nephrectomy for renal cell carcinoma—does it affect survival?J Urol 2008; 179: 2152. Link, Google Scholar
- 14. : How long can patients with renal cell carcinoma wait for surgery without compromising pathological outcomes?Can Urol Assoc J 2011; 5: E148. Google Scholar
- 15. : The impact of delaying radical nephrectomy for stage II or higher renal cell carcinoma. J Cancer Res Clin Oncol 2012; 138: 1561. Google Scholar
- 16. : The effect of delaying nephrectomy on oncologic outcomes in patients with renal tumors greater than 4 cm. Urol Oncol 2016; 34: 239.e1. Google Scholar
- 17. Canadian Surgical Wait Times (SWAT) Initiative: Consensus document: recommendations for optimal surgical wait times for patients with urological malignancies. Can J Urol, suppl., 2006; 13: 62. Google Scholar
- 18. : AJCC Cancer Staging Manual, 7th ed.Chicago: Springer 2010. Google Scholar
- 19. : Anatomic features of enhancing renal masses predict malignant and high-grade pathology: a preoperative nomogram using the RENAL nephrometry score. Eur Urol 2011; 60: 241. Google Scholar
- 20. : Multiphasic enhancement patterns of small renal masses (≤4 cm) on preoperative computed tomography: utility for distinguishing subtypes of renal cell carcinoma, angiomyolipoma, and oncocytoma. Urology 2013; 81: 1265. Google Scholar
- 21. : Comparative effectiveness for survival and renal function of partial and radical nephrectomy for localized renal tumors: a systematic review and meta-analysis. J Urol 2012; 188: 51. Link, Google Scholar
- 22. : Partial nephrectomy versus radical nephrectomy for clinical T1b and T2 renal tumors: a systematic review and meta-analysis of comparative studies. Eur Urol 2017; 71: 606 Google Scholar
- 23. : Radical versus partial nephrectomy for cT1 renal cell carcinoma. Eur Urol 2018; 74: 825 Google Scholar
- 24. : Routine adrenalectomy is unnecessary during surgery for large and/or upper pole renal tumors when the adrenal gland is radiographically normal. J Urol 2011; 185: 1198. Link, Google Scholar
- 25. : Small renal masses progressing to metastases under active surveillance: a systematic review and pooled analysis. Cancer 2012; 118: 997. Google Scholar
- 26. : The natural history of large renal masses followed on observation. Urol Oncol 2018; 36: 362.e17. Google Scholar
- 27. : Timing the landmark events in the evolution of clear cell renal cell cancer: TRACERx renal. Cell 2018; 173: 611. Google Scholar
