Clinical genitourinary cancer · 2026
Prolonged Surgical Waiting Time for Radical Nephroureterectomy Is Associated With Worse Survival Outcomes in Patients With Upper Tract Urothelial Carcinoma.
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Motoki Yusuke, Sano Takeshi, Yoshida Takashi, Nakamoto Takahiro, Ikeda Junichi, Yoshida Ryuichi, Taguchi Makoto, Mishima Takao, Taniguchi Hisanori, Yanishi Masaaki, Kinoshita Hidefumi
Аннотация
INTRODUCTION: We aimed to identify a candidate cutoff for surgical waiting time from diagnosis of upper tract urothelial carcinoma to radical nephroureterectomy and compare survival outcomes between early and delayed surgery groups.
PATIENTS AND METHODS: We retrospectively analyzed 435 patients with upper tract urothelial carcinoma who underwent radical nephroureterectomy without neoadjuvant chemotherapy (June 2004-December 2022). A time-dependent receiver operating characteristic approach was used to identify a candidate cutoff of surgical waiting time, and the patients were categorized into early and delayed surgery groups. Between-group imbalances were adjusted using inverse probability of treatment weighting, and we compared overall survival, cancer-specific survival, and recurrence-free survival. Sensitivity analyses treated waiting time as a continuous variable.
RESULTS: By the receiver operating characteristic analysis, 435 patients were classified into early (<43 days) and delayed (≥43 days) surgery groups, comprising 217 and 218 patients, respectively. After inverse probability of treatment weighting adjustment, overall survival was significantly worse in the delayed surgery group than in the early surgery group (hazard ratio [HR] 1.43, 95% confidence interval [CI] 1.02-2.00, P = .039) whereas no significant differences were observed in cancer-specific survival (HR 1.39, 95% CI 0.89-2.17, P = .144) or recurrence-free survival (HR 1.44, 95% CI 0.98-2.12, P = .061). Upstaging from clinical <T3 to pathological ≥T3 occurred more frequently in the delayed surgery group than in the early surgery group, but was not statistically significant (26.9% vs. 21.1%, P = .172).
CONCLUSION: A surgical waiting time of ≥43 days from upper tract urothelial carcinoma diagnosis to radical nephroureterectomy was associated with worse overall survival in the primary dichotomized analysis. However, continuous analyses did not show a consistent linear association. Thus, approximately 6 weeks should be regarded as a hypothesis-generating benchmark rather than a universal threshold.
PATIENTS AND METHODS: We retrospectively analyzed 435 patients with upper tract urothelial carcinoma who underwent radical nephroureterectomy without neoadjuvant chemotherapy (June 2004-December 2022). A time-dependent receiver operating characteristic approach was used to identify a candidate cutoff of surgical waiting time, and the patients were categorized into early and delayed surgery groups. Between-group imbalances were adjusted using inverse probability of treatment weighting, and we compared overall survival, cancer-specific survival, and recurrence-free survival. Sensitivity analyses treated waiting time as a continuous variable.
RESULTS: By the receiver operating characteristic analysis, 435 patients were classified into early (<43 days) and delayed (≥43 days) surgery groups, comprising 217 and 218 patients, respectively. After inverse probability of treatment weighting adjustment, overall survival was significantly worse in the delayed surgery group than in the early surgery group (hazard ratio [HR] 1.43, 95% confidence interval [CI] 1.02-2.00, P = .039) whereas no significant differences were observed in cancer-specific survival (HR 1.39, 95% CI 0.89-2.17, P = .144) or recurrence-free survival (HR 1.44, 95% CI 0.98-2.12, P = .061). Upstaging from clinical <T3 to pathological ≥T3 occurred more frequently in the delayed surgery group than in the early surgery group, but was not statistically significant (26.9% vs. 21.1%, P = .172).
CONCLUSION: A surgical waiting time of ≥43 days from upper tract urothelial carcinoma diagnosis to radical nephroureterectomy was associated with worse overall survival in the primary dichotomized analysis. However, continuous analyses did not show a consistent linear association. Thus, approximately 6 weeks should be regarded as a hypothesis-generating benchmark rather than a universal threshold.