BJU international · 2026
The effect of time to nephrectomy on cancer-specific mortality in pathological T stage (pT)1b-2 renal cancer.
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Nicolazzini Michele, Polverino Federico, Quarta Leonardo, Filzmayer Maximilian, Petix Michele, Catanzaro Calogero, Lee Nick, Goyal Jordan A, Longo Nicola, Musi Gennaro, Chun Felix K H, Briganti Alberto, Schiavina Riccardo, Shariat Shahrokh F, Palumbo Carlotta, Volpe Alessandro, Saad Fred, Karakiewicz Pierre I
Аннотация
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.
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.