Time to Partial Nephrectomy Versus Cancer-Specific Mortality in 2 to 4 cm Renal Cell Carcinoma.

INTRODUCTION

Longer time to surgical treatment (TTST) may adversely affect cancer-specific mortality (CSM) in 2 to 4 cm localized renal cell carcinoma (RCC) treated with partial nephrectomy (PN). This effect may be more pronounced in younger individuals.

METHODS

Patients were identified within the Surveillance, Epidemiology and End Results database (2004-2021) and stratified according to TTST ≤ 3 versus > 3 months. After propensity score matching (PSM), multivariable competing risks regression (CRR) models were fitted. Several upper age inclusion thresholds were tested.

RESULTS

TTST > 3 months was recorded in 2409 of 8947 (26.9%) PN patients. Over time, the proportion of PN patients with TTST > 3 months increased from 18.2% to 33.0% (P < .001). After PSM, TTST > 3 months independently predicted higher CSM (hazard ratio [HR] 1.62, 95% CI 1.17-3.15, P = .010) in patients aged ≤ 67 years, but not in older patients. Multivariable models with different upper age inclusion thresholds revealed that TTST > 3 months exerted the strongest effect (HR 2.76, 95% CI 1.03-7.35, P = .043) in youngest individuals (aged ≤ 55 years).

CONCLUSION

Increasingly larger proportions of PN patients experienced prolonged TTST (> 3 months). Its adverse effect on CSM applies to individuals aged ≤ 67 years and becomes progressively more important with decreasing age. In consequence, efforts aimed at minimizing TTST should predominantly target young PN candidates.