During the COVID-19 pandemic, elective surgery has to undergo longer wait times, including nephrectomy for T1 renal cell carcinoma (RCC). This study aimed to investigate the time-to-surgery (TTS) of Chinese T1 RCC patients and its influencing factors, and to illustrate the impact of TTS on the prognosis of T1 RCC.
We retrospectively enrolled 762 Chinese patients with pathological T1 RCC that underwent nephrectomy. To discover the impact of TTS on survival outcomes, we explored the possible delay intervals by week using the Kaplan-Meier method and Log-rank test. Cox proportional hazard models with inverse probability-treatment weighting (IPTW) were used to assess the association between TTS and disease-free survival (DFS) and overall survival (OS).
The median TTS of T1 RCC patients was 15 days. The Charlson comorbidity index, the Preoperative Aspects and Dimensions Used for an Anatomical (PADUA) score, and the maximal tumor diameter on presentation were independent influencing factors for TTS. The cut-off point of TTS was selected as 5 weeks according to the Log-rank analysis. For T1a RCC, patients with TTS > 5 weeks had similar DFS (HR = 2.39; 95% CI, 0.82-6.94; p = 0.109) and OS (HR = 1.28; 95% CI, 0.23-7.16; p = 0.779) compared to patients with TTS ≤ 5 weeks. For T1b RCC, patients with TTS > 5 weeks had shorter DFS (HR = 2.90; 95% CI = 1.46-5.75; p = 0.002) and OS (HR = 2.49, 95% CI = 1.09-5.70; p = 0.030) than patients with TTS ≤ 5 weeks.
Prolonged TTS had no impact on the prognosis of T1a RCC while surgery delayed for over 5 weeks may lead to worse survival in T1b RCC.
Journal of clinical medicine. 2022 Dec 19*** epublish ***
Wei Ou, Changxuan Wang, Hiocheng Un, Shengjie Guo, Han Xiao, Bin Huang, Bin Li, Jiahao Lei, Jinhuan Wei, Sui Peng, Junhang Luo, Zongren Wang, Lingwu Chen
Department of Urology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China., Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou 510080, China., Clinical Trials Unit, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China.