The effect of time to nephrectomy on cancer‐specific mortality in pathological T stage (
pT)1b
–2 renal cancer
Michele Nicolazzini, Federico Polverino, Leonardo Quarta, Maximilian Filzmayer, Michele Petix, Calogero Catanzaro, Nick Lee, Jordan A. Goyal, Nicola Longo, Gennaro Musi, Felix K. H. Chun, Alberto Briganti, Riccardo Schiavina, Shahrokh F. Shariat, Carlotta Palumbo, Alessandro Volpe, Fred Saad, Pierre I. Karakiewicz Objective
To assess the impact of prolonged time to surgery on cancer‐specific mortality (CSM) in patients with pathological T stage (pT)1b–2 N0M0 renal cell carcinoma (RCC) treated with nephrectomy (either partial [PN] or radical [RN]). Within the Surveillance, Epidemiology and End Results (SEER) database (2004–2021), we tested the effect of time to surgery >3 vs ≤3 months on CSM in patients with pT1b‐2N0M0 RCC.
Patients and Methods
Propensity score matching (PSM) and multivariable competing risks regression (CRR) were performed. Subgroup analyses stratified patients according to time to surgery interval (≤1 vs 1–3 months, ≤3 vs 3–6 months, ≤3 vs >6 months), histotype, and grade.
Results
Of 16 322 patients with pT1b–2 RCC treated with nephrectomy, time to surgery >3 months was recorded in 3023 (18%) patients. These patients were older (median age 64 vs 62 years) and harboured a smaller proportion of pT2 patients (19% vs 30%). After one‐to‐one PSM, 3023 (100%) patients with a time to surgery >3 months exhibited a 60‐month CSM of 7.6% vs 5.9% in 3023 (23%) patients with a time to surgery ≤3 months. In CRR time to surgery >3 months independently predicted 1.3‐fold higher CSM ( P = 0.02). Subgroup analyses revealed a dose–response effect, with a CSM increase in 1.3‐fold fashion when time to surgery was 3–6 months vs 1.6‐fold fashion when time to surgery was >6 months. The detrimental effect of time to surgery>3 months was consistent across all grades but was not evidenced among patients with a non‐clear cell RCC.
Conclusion
In patients with pT1b‐2N0M0 treated with either PN or RN, prolonged time from diagnosis to surgery was associated with higher CSM. This association was not observed among patients with non‐clear cell RCC.