AUA 2020: The Impact of Delay in Care on Renal Cell Carcinoma Outcomes: Analysis Based on Tumor Size

( In the context of significant operative slow-downs as a result of COVID-19, there has been a renewed interest in the effect of treatment delays in urologic oncology. In a podium presentation at the American Urologic Association (AUA) 2020 Virtual Annual Meeting, Devin Patel, MD, and colleagues present an analysis assessing the effect time to definitive surgical treatment on survival outcomes, stratified by tumor size in a group of young, healthy patients from the National Cancer Database (NCDB).

The authors utilized the NCDB to identify young (age <60 years) and healthy (Charlson comorbidity score of 0) patients with localized renal cell carcinoma (RCC) (cT1-T3N0M0) diagnosed between 2004 and 2015. The authors categorized patients in quartiles based on the duration of time from diagnosis to surgery in days, with delayed treatment as the fourth quartile. Patients were then stratified on the basis of primary tumor size: <2 cm, 2-4 cm, 4-7 cm, and >10 cm. The primary outcome was overall survival (OS) between early and delayed groups. This was examined using Kaplan-Meier analysis and Cox proportional hazards, stratified by tumor size. The secondary outcome was to identify associated with delays in care. Logistic regression was performed for the secondary outcome. In each analysis, results were adjusted for age, race, sex, location, income, education, and insurance.

A total of 44,149 patients were identified. Median time to treatment was 35 days (IQR 19-61). Early (n=33,144) and delayed (> 61 days, n =11,005) groups had a mean follow-up of 61.5 and 57.5 months, respectively (p < 0.001).

On univariate Kaplan Meier analysis, 5-year OS was worse in patients with surgery delay versus no surgery delay for patients with tumors larger than 2cm: tumors 2-4 cm in size (5-year OS 49% vs. 54%; p<0.001), 4-7 cm (5-year OS 47% vs. 53%; p<0.001), >7 cm (5-year OS 45% vs. 49%; p=0.0002). There was no significant difference for patients with tumors <2 cm in size (5 year OS 49% vs. 51%: p=0.5848).

On multivariable Cox proportional hazard modelling, these results were recapitulated with treatment delayed associated with worse OS in patients with tumor size 2-4 cm (HR 1.24; p=0.001), 4-7 cm (HR 1.32; p<0.001) and >7 cm (HR 1.14; p=0.034) but not tumors <2 cm (HR 0.83; p=0.123).

Factors associated with delay in treatment included older age (OR 1.01; p<0.001), male sex (1.11; p<0.001), non-private insurance (OR 1.44; p<0.001), black race (OR 1.60; p<0.001), decreased education (OR 1.11; p<0.001) and tumors <2 cm (OR 1.23; p<0.001).


Presented by: Devin Patel, MD, University of California, San Diego, Los Angeles, CA, USA 

Written by: Christopher J.D. Wallis, Urologic Oncology Fellow, Vanderbilt University Medical Center, Nashville, TN, Twitter: @WallisCJD, at the 2020 American Urological Association (AUA) Annual Meeting, Virtual Experience #AUA20, June 27-28, 2020. 

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