This study aimed to evaluate the oncological outcome of delayed surgical wait time from the diagnosis of upper tract urothelial carcinoma (UTUC) to radical nephroureterectomy (RNU).
In this multicenter retrospective study, medical records were collected between 1988 and 2021 from 18 participating Taiwanese hospitals under the Taiwan UTUC Collaboration Group. Patients were dichotomized into the early (≤90 days) and late (>90 days) surgical wait-time groups. Overall survival, disease-free survival, and bladder recurrence-free survival were calculated using the Kaplan-Meier method and multivariate Cox regression analysis. Multivariate analysis was performed using stepwise linear regression.
Of the 1251 patients, 1181 (94.4%) were classifed into the early surgical wait-time group and 70 (5.6%) into the late surgical wait-time group. The median surgical wait time was 21 days, and the median follow-up was 59.5 months. Our study showed delay-time more than 90 days appeared to be associated with worse overall survival (hazard ratio [HR] 1.974, 95% confidence interval [CI] 1.166-3.343, p = 0.011), and disease-free survival (HR 1.997, 95% CI 1.137-3.507, p = 0.016). This remained as an independent prognostic factor after other confounding factors were adjusted. Age, ECOG performance status, Charlson Comorbidity Index (CCI), surgical margin, tumor location and adjuvant systemic therapy were independent prognostic factors for overall survival. Tumor location and adjuvant systemic therapy were also independent prognostic factors for disease-free survival.
For patients with UTUC undergoing RNU, the surgical wait time should be minimized to less than 90 days. Prolonged delay times may be associated with poor overall and disease-free survival.
Frontiers in oncology. 2022 Dec 14*** epublish ***
Kuan-Hsien Wu, Chao-Hsiang Chang, Hsi-Chin Wu, Steven K Huang, Chien-Liang Liu, Cheng-Kuang Yang, Jian-Ri Li, Jen-Shu Tseng, Wun-Rong Lin, Chih-Chin Yu, Chi-Wen Lo, Chao-Yuan Huang, Chung-Hsin Chen, Chung-You Tsai, Pai-Yu Cheng, Yuan-Hong Jiang, Yu-Khun Lee, Yung-Tai Chen, Ting-Chun Yeh, Jen-Tai Lin, Yao-Chou Tsai, Thomas Y Hsueh, Bing-Juin Chiang, Yi-De Chiang, Wei-Yu Lin, Yeong-Chin Jou, See-Tong Pang, Hung-Lung Ke
Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan., Department of Urology, China Medical University and Hospital, Taichung, Taiwan., Division of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan., Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan., Department of Urology, MacKay Memorial Hospital, Taipei, Taiwan., Division of Urology, Department of surgery, Taipei Tzuchi Hospital, The Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan., Department of Urology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan., Divisions of Urology, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan., Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan., Department of Urology, Taiwan Adventist Hospital, Taipei, Taiwan., Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan., School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan., Division of Urology, Department of Surgery, Taipei City Hospital Renai Branch, Taipei, Taiwan., College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan., Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan., Division of Urology, Department of Surgery, Chang Gung Memorial Hospital at Chiayi, Chiayi, Taiwan., Department of Urology, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi, Taiwan., Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.